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ORAL HEALTH 



VOLUMK VI 
1916. 

EDITOR: 

Wallace Scccombc. D.D.S.. I oronlo, Canada 



CON IKIBLTING EDITORS 

F. W. Barbour. D D.S Frrdrrcton. N.B. 

J WriRhl Bracli. D D S Buffalo. NY. 

J K. Black. D I) S Vancouver. B C. 

Manly liowlcs. D.D.S Vl'inni(>cg. Man. 

r:dwarcl 1) Coolidgc. D.D.S Chicago. III. 

W. I .. ( umrnrr. D.D.S I'oronto. Out. 

i:. M. Doylv. I) I) S Calgary. Alia 

J A C. Hoggan. D.D.S Kichmond. \'a 

Kichard Ci. McLaughlin. D.D.S I r.nto. Onl 

George K I homson, D.D S I l.»lif«ix, N S. 

r. W W'iddowson. L.DS ' ::J .. I'jigUnd 



MULlLiM IN I\\I<VC) DKPAKTMFNT 
C. A. Kennedy. P D.S., Toronto. Canada. 



I HI COMPI NDIIM: 
rhomas Cowling. D.D.S.. Toronto. Canada. 



Published by 

ORAL HI Aim PrBl.l.^HINGCO. 

Toronto. Can.wl.i 



Index — Volunjf- \ I 



I'llUTUCiKAI'lI.S. 

Arrjold. K. F.. Toronto 476 

Ash. Charlen K.. Ii.I»S. Now 
York Clly 1 

flpd of TuIipN. Grlm.Hb>. un- 
larlo 253 25'. 

I'allachey. the latp Major V. P.. 

D.D.S., Hranlford. Ont 271 

Cummer. VV. K.. D DS . T. P S . 

Toronto. Ont. \'j 

Clayton. Lleul.-Col. W . ii.. Ui- 
lawa. Ont 92 

Clark. Donald. D.D.S.. Hamil- 
ton. Ont 230 

C.A.D.C. Inspection at Camp 
Horden 400 

C.A.D.C. nunding.><. lamp 
Borden 416 

C.A.D.<'. Offlce.H. Camp HuKhis. 
Man 463 

C.A.D.C. Duck ShootlnK. Camp 
IIuKhe.M. Man !• 

Frt^Mhmen Cla.ns 1916-17. H.C. 
D.S 494 

C.roup of OfflcerH. C.A.D.C. In 
KnKlanu 136 

(;ilmir. Thoma« L.. M.D.. 
D.D.S.. Sc.D.. Chicago i' 

(Jreen. ho late Jacob \S . 
D.D.S . Detroit 211 

Idyl PineH. (ieor^ian \\h\ : ••; 

JapaneHc Iris 471 

LouU'. Major UrniTal li.U.C. 

M D. No. 2 4<>6 

MacLaurin. the late Capl. II J . 

D.DS. WinnlpoK. Man 36.' 

McLauKhlln. Capt C K.. Can- 
adian (teneral Ilonpilal No. 
2. France 450 

Mitliarx MoHpilal CanPH 

152. 4;>.. 454. 455. 456. 457 

OfTlj i'« and n»»'n. Canip HjKh«»n 464 

Pr(ini«'i( . . 427 

IVonien. Delphinium :3R. ?"'* 

Sale, the lair Major Chan. K. 
D.DS.. C.odirlrh. Ont .. 

Stanton. F. K.. D.DS \. » 
York City I**: 



Sl Thoman llortlrulfurul sio. 
cieiy |g2 

Thom.i-. Ho .. D.DJi.. L.DH^ 
L<in«ion, Or.f ^tt 

ThonipHon. Major W. O, A.I 
DS \f '• No. 2 40J 

Tho: Major W r, T..nl. 

Camp Iiord«>n . ' n^ 

WriKht. Major W. W, A.DJi.S.. 
M D. No 10 i^j 

MST .ir I ONTRIIUTOIliJ. 

AMh. C. F.. D.D^^ Ntw York 
i'ltjr -. 

Amy. W. B.. D.D^.. Torooto 
Arm.Mironif. Lt.-Col. J. A. . 121. 4«« 
Ant.«. Irwin H.. D.. j>.. Toronto 231 
Mrookn. B. U. D.D^.. Lyneb- 

buric. Va. fg^ 

Flurk'egn. J. K . !>!>?? Svw 

York Cll\ 399 

Huntlnu. K w.. lUi.Sc.. Ana 
Arbor. .V.lcb JJJ 

Hrethour, P. O, D.D« To- 
ronto • 4(9 

Howlen. Manly. Dfv.s v..* 
York City sff 

Cowling. Thoniaa. I>.l)^.. To- 

ronio ff 

•ummer. W. B.. n.DIt To- 

ronto I J5f 

Carney. Matthew. DM • 

York Cit> 1(1 

..>,! ' sas 

Day. Arthur. 1X08. Toronlo. ItS 
Fnniua. Ikrnard. M.U. • 



III 



<:ilmrr. Thou. L^ UAK IVDo 
Sr D I. 

Gardiner. B. R. DPS T.rnnfo (I 

tJIffen. \Vn» V 

froit 211 

llrtbrc (J W Tirtkch 

Ilufrfclo) 1' 

H e. II K. M *' 193 

11.^... * n !»»»< \- 

C|!\ •♦ 



INDEX.— (Continued.) 



Page. 
Jarvis, R. D., 'D.D.S., London, 

Ont 313 

Johnson, C. N., M.A., L.D..S., 

D.:D.S., Chicago, 111 394 

Marshall, Capt. J S., M.D., 

Sc.D., F.A.CS 376 

Merkley, H. J., M.D.S., D.D.S. , 
Winnipeig, Man 407 

Minns, the late Clarence R., 

D.D.S 12 

Moorehead, F. B., D.D.S 477 

McLaughlin, Capt. Chas. E.... 451 

McCleave, T. C, M.D., Oakland, 
Cal 481 

Pearson, W. H., D.D.S., Nor- 
folk, Va 76 

Palmer, S., D.'D.S., Pough- 
keepsie, N.Y 373 

Reade, R. J., M.A., D.-D.S., 
'M.D.C.M., Toronto 275 

Ryan, E. P. R., D.D.S., New 
York 438 

Roberts, Major J. G., Military 
Convalescent Home, To- 
ronto 279, 459 

Seccombe, Wallace, D.D.S., To- 
ronto 109, 253, 415, 524 

Stillman, Paul R., D.D.'S., New 
York City 166, 385 

Stanton, F. L., New York City 183 
Schneider, A., Ph.D., M.D., San 
Francisco, Cal 369 

Trelford, Capt. W. G., Toronto. 119 

Whitt, M. E., Abingdon, Va. ... 173 

Williams, W. P., D.DJS., Brook- 
neal, Va 269 

Wright, C. S.. M.D., Toronto.. 366 
Wright, Major W. W., A.D.D.iS., 
M.D. No. 10 461 

ORIGINAL CONTRIIBUTIONS. 
Appreciation of the late Major 
C. E. Sale, D.D.S 24 

Appreciation of the late Dr. 
Green 211 

Appreciation of the late Major 

P. P. Ballachey 285 

Apipreciation of the late Howard 

James McLaurin, D.D.:S 392 

Buffalo Letter 8, 137, 345 

Census of Canadian Dentistry. 524 
Chronic Oral Infections, Their 
Relations to Diseases in 

Other Parts 47 

Correct Basis for Fixing the 
Dental Fee, The 2'87 



Page. 

Conductive Anesthesia 313 

C.A.D.C. in Military District 
No. 2, The 415 

C.A.D.C. in Military District 
No. 10, The 461 

Dental Services in a Toronto 
Orphanage 162 

Dental Clinics for the Children 
of New York 164 

Dental Surveying in Arch Pre- 
determination — New Evi- 
dence in Favor of Early 
Treatment 183 

Dentists' Hobby, A 253, 282 

Direct and Indirect Method of 
Casting Base for Crowns . . 256 

Demonstrating Blow Torch 
iMethod of Cast and Solder 
Work 269 

Dental Hygienists 275 

Dominion Dental Council 418 

Dentists in Active Service May 
Secure OflSce Assistant 437 

Dental Services, Returned 
iSoldiers 459 

Growth of the C.A.D.C, The.. 119 

Gassing and Its Effect on the 

Oral Tissues 279 

Horticulture for the City 

Dentist 337, 425, 469 

Health, Dental Service and Ef- 
ficiency 363 

Importance of Correct Posture 
with special reference to the 
use of the Feet 366 

Inspection of C.A.D.C. by Major- 
General Hughes ". . . . 400 

Local Anesthesia With Use of 
Anocain 64 

Local Anesthesia for the Gen- 
eral Practitioner 408 

Management of Children and the 
Treatment of their Teeth . . 12 

Operations Performed by C.A. 
D.G. Overseas 121, 272, 400 

Oral Surgery and the War . . . 451 

Partial Dentures 93, 144, 239 

Periodontia for the General 
Practitioner 166 

Preparation of Abutments and 
Construction of Pinlay andi 
Pinledge Attachments for 
Bridge Work 299 

Report of the Free Dental Dis- 
pensary, Poughkeepsie, N.Y. 373 



INDEX.— (Continu«d) 



I'aK'- 
Halation of the Mouth to (n-n- 
••ral Sln'pto<o<cu« Inf«Ttlon. 497 

Ueiiiovablf IlridK^'Work on Non- 
vital Abutnuntu 3 

Soldering? and ItM DifflcultiPii. . 231 

hpllnt for Fractured Mandible. 76 

SucceiiHrul Practice of Den- 
tlalry. The 109 

Silicate Restoration of PeK- 
Shaped Lateral Incinor 173 

Travt'Ilink' Di'ntal Surgery In 
ihr l''n'n(h Army 521 

Value of Oral HvKlene lectures 
to the I»ublic and the Ke- 
.HponHibllity of the Dental 
I'r ofrsHion in Relation to this 
Worlt. Th.- 319 

SKLhX'TKD ARTK'LKS. 

Care of Children'}* Teeth. The. 481 

Military Efficiency Depend.n 
LaPKely I'pon lh»' Teeth .... 17K 

MicroHcopic F^xamination of 
Finger Nail DeportllH. Thi- .. 369 

Minister of .Militia Praises 
<*.A.I).(' 467 

New Militia Order CoverlnK 
C.A.D.r 4Hy 

Prescription Writing in Eng- 
lish 292 

I»revenllve I)entiH;r> 323 

Periodontia 3Ko 

Research Fund of the National 

Dintal Association. The 394 

Russian Wonien Dentistj* 20 

Sterilization of h.nf.il Instru- 
menlH. Th«' ... 192 

Septic Teeth 376 

Seven Fnerupted Teeth in the 
Superior .Maxilla ... 438 

Technique of Root Cuuiil FlllinR 341 

MIS<'KLLANhX)rS 

Army Dental Fund of i'.D.A . 
The 21. 22«. r>23 

Active Sirvlce Roll ... 38. S6. 

12N. 174. 222. 304. 354. 39K. 444. 490 
AddresH hy .Major Clayton. 

Acllng D.D.S.. C.ADC 7t 

Advantages of Ifaicleria 31 4 

Acknowledgment of Servlcen 

Dr. John Teelxel. Hrrniuda. 127 

College of I>«*ntal Surgeonf^ of 
Qu.bec 136 



Dental Work in ToroBlP 
lIcMpital ?• 

D.D.C. ExamlDatloD Rr^ 

1916 i»6 

I'Mucatlon Thf Snt-iml Inafru. 

Ment <» 

r .»: 

Front Mi. nt 

<;reat .N- utaamx Mailer 
at th« 7S 

(flycerlne As An Ant: : <3 

ilospiial -4 

iH-ntal T: Ml 

Important I^egal Dr« 

Manitoba Court.<t . .i> 

Important Announrr: v 

Dr. W. E. Commer It 

.More I>entiiita Wanted a-, inr 

Front Its 

Ontario Temperance Act M It 
Affects D' S14 

i*ost (iradu-t v^» In fVn'al 

Prosthetics :lf 

J*roceeding ' '' •• 

CADC. fSt 

The Tooth Ilrush 44 

SOCItrrY PRO! I -. 

American Ifi.**! iMi'i- . »! 

Teachen* « 4t 

Annual Conf*;- 

tarlo Oral H> . 

of the O.DS .472 

Chicago Dental S— - • 

.Meeting 7t 

Canadian l>ental Aimiocis 

Dental Manufacturers K^ 
New Features 

tUstern Ontario Dtn 
vent Ion .'21 

I vr Manufaclur«*r'e h\ 

i 

Imprt'ivlons of S4th 

M. ^ 

tu • '^ * 

Maritime Dental N IT 

Mretlnir nf Jhr Kt- *: 

o I • *T 
\ .1 • 

r IT 

National Drnial A t; 



INDEX.— (Continued.) 



Page. 

Ontario Dental Society 122 

Toronto Rifle Club Officers.. 37 

Toronto Dental Society 

122, 228. 488 

Western Canada Dental Society 272 
EDITORIiALS. 

A Modern "Rip-Van-Winkle" . . 89 

Activities of the C.A.D.C .in 
Canada 447 

Canadian Department of 
Health, A 130 

Canadian West and Four Year 
Course ^30 

Canadian Dental Association, 
The 402 

Dental Clinics in School Build- 
ings ^^^ 

Dental Research in Canada ... 41 

Dental Hygienist and Pre- ^_ 
ventive Dentistry, The 358 

Dentist and Mal-.practice Suits, 
The 446 

Dr. W. E. Cummer to Editorial 
Staff Oral Health 530 

Hygiene and Dentistry 271 

New Establishment C.A.D.C... 131 

Plea for More Uniform Legis- 
lation, A 315 

Recent Dental Legislation in 
Manitoba 226 

Two Chamber Dental iSteril- 

492 
izers ^^-' 

War Time Demand for Dentists 88 

What is Unprofessional Con- 
duct? l'^9 

X-Ray Plates May be Shown to 
Juries 227 

1917— What? 528 

EDITORIAL NOTES. 

British Dentist Honored by 

King 360 

Casualty, C.A.D.C. 134 

Canadian Dentists at the 

Front 360 

Capt. Orville A. Elliott, C.A. 

ID.C, Toronto 494 

Dr. Frank E. Bennett, Board 

of Education, St. Tliomas ... 44 
Dr. Cummer's Complete Article 134 



Page. 
Do You Love Flowers? Have 
You a Garden? 316 

Dean Hpff, of Ann Arbor, Re- 
signs 404 

Good Public Service Performed 
by Mayor Cowan 227 

horticulture as a Hobby for 

the Dentist 448 

Illness of Dr. W. E. Willmott. 494 
Lieut, McLaurin Wounded .... 134 

Mayor W. D. Cowan, Regina, 

(Sask 44 

Major Clayton on Western Tour 134 

Ninety-six Freshmen at the 
R.C.D.iS 494 

Oral' Clinics Badly Needed ... 403 

R.C.D.S. Matriculation 493 

Two Names Added to Honor 

Roll 316 

To Encourage Student Reading 493 

CORRBSPONDENCE. 

Armstrong, Lt.-Col. J. A 123 

Les'ie, Capt. Oliver 124 

Letters From Our Boys at the 
Front 525 

Mallory, Capt. F. R 23 

Roiberts, Surgeon General J. A., 

Salonika, Greece 126 

Smith, Major A. A 123 

Seasonable Letter From One of 
the Editorial Staff, A 356 

MULTUM IN PARVO. 

Pages 40, 84, 176, 224, 270, 353, 401, 

441 

THE COMIPENDIU'M. 

Pages 2'6, 79, 217, 263, 306, 348, 429, 

473, 512 

ORAL HYGIENE REPORTS. 

Pages 43, 212, 303, 357, 360, 440, 458 

OIBITUARY. 

Both well, Mrs. J. A., Toronto. 303 
Marshall, J. P., D.D.S., To- 
ronto 25 

McElhinney, Aubrey, D.D.S., 
Ottawa 404 



Trood (rrtli at fiftv proclaim 
fainilv character, conserve 
facial contour, ami insure 
food conilort.' " 





Charles F. Ash, D. D. S. 
New York City 



w 



SL 



w 



OI^AL HEALTA1 

A JOIHNM IIIM s| vM»s ho|{ IIIF iMNih • »► 
PKKM-.M ION. • \N u H I \xiHF ' ('Ol Mi o^ « I MK 



^ 



\()|.. (. 



'H MK IN H ». I \M \i: V |'>|<. 



No. 1 



Removable Bridgewcrk on iNon-Vital Abutment: 



Charles F. Ash. New ^'ork Cmr. 



Wt i/\ I procedure we shall follow in making a restoralion by 
means of bridge is a subject not lo br considered lightK 
f.very operator shoiiUi base his prognoMS on the qucitioo. 
"How can I give my patient the best possible srrvKeV IliCT^ mrr 
so many eh-mrnts that may be involved m this (|urslion th«l il »• 
almost impossible to enumerate them all the ability of the ofKtAlov. 
the general condition of the mouth as to pyorrhea, the (XMsibthty of 
kerpinv^ lh«' mouth chan after ihr bridge is made, efficiency in matli- 
r.ilion. dui.ibilily of lh<- abulmrnls. health of the patient 
Let us assuiiu' for the- v.ikf of argument that no srf^ic a 



[In a letter to OraI. HkaI.TH. Dr A%h Wulo t jar 

advocati'ii h\j the author hcforc the CVrifni^ H ":... .i... ;: of 

Xelv JeneV in Xoveniher, 1911, and pu at thai timt iff 

ITEMS OF INTEKl'lST. is more or 1cm ohioUte lor the reaum 

that the Hm^ejomt attaihment is no longer uied Sf i of the 

professioti will he tjhul to learn that l^r Afh*% mor 

will he pji/Wi\/ir(/ in the near future, he having eon^ 

f^aper upon the suhjeet before the leeond distri<t Dental 

/VcD' York. rj)ITOR I 



-f a 



* RcmI b«for« thr loronlo P^nl.l So. ►♦«?. Nor»»h*f. !'»"■ 



4 ORAL HEALTH 

will ever occur at the apex of a devitalized tooth, and that a dead 
tooth is just as good as a live one. 

Now let us ask ourselves — Is a fixed bridge as good as a remove- 
able one? I will grant, if you please, that the masticating efficiency 
of one is as good as the other. Very well, so far there is no difference. 

The next question is: Can a fixed bridge be kept as clean as a 
removeable bridge? No intelligent layman would say yes; and cer- 
tainly no intelligent dentist would claim that it could. Very well, 
then let us ask: Is cleanliness an important or desirable factor? Let 
me answer this by quoting from Dr. Henry Gillett's discussion of Dr. 
Schamberg's paper on "Dentistry, a Blessing or Curse." 

October 4, 1915. 
Henry W. Gillett, D.M.D. 
(Discussion of Dr. Schamberg's Paper.) 

"Hunter's indictment of septic dentistry came none too soon, nor 
was it too severe. Out of it grew a vast amount of explanation on 
our part that failed to explain. We called loudly for more co-opera- 
tion by medical men, we pointed out their neglect of the mouth, and 
cited in triumph our fixed bridge work cases that had been success- 
ful in spite of their defects, and we laid it all on the other fellow. 

Fortunately, we did something more. Here and there among us 
men began scrutinizing methods, processes and results. Observation, 
comparison, consultation with general practitioners bore fruit. 

More and more men are realizing that only after careful diagnosis 
of all the conditions of a given mouth, and consideration of its rela- 
tion to the rest of the organism, may they safely attempt dental treat- 
ment. More and more dental practitioners are realizing that if they 
advise, assent to, permit or fail to condemn the retention of septic 
foci in the mouth, they are morally responsible for the health ani 
lives of their patients. 

I dislike to contemplate what may be the legal responsibility of 
the practitioner who thus fails. 

Lest I generalize too much, and so fail to make myself clear, I 
will mention certain specific details of diagnosis and procedure. The 
universal experience of men who have used radiagraphy in all their 
root canal work for even one month, is that they no longer dare to 
do root canal work without its assistance, as they might incur respon- 
sibilities that no careful man would wish to carry. 

Especially do we need better diagnosis in our daily work — earlier 
recognition of gingival irritation. We have recently been saddened 
by the loss from our ranks of the ablest scientist dentistry has ever 
known, Dr. Greene Vardimn Black. I am filled with gratitude that 
he was spared to complete his "Special Dental Pathalogy," pub- 
lished last spring. If every practitioner in this room would read, 
digest and apply the principles he enunciates, for the care and pro- 
tection of gingivae, it would roll up such a record of achievement in 



ORAL HKAl/I H 5 

[)rcvrntivc medicine as lo be an unequalled monument of hu life work. 

My remark concerning fixed bridge work will arouse de^) oppoM- 
tion in the minds of some of you. I o those I make this chailenffe — 
take the May. 1915, number of "hem* of Inl'*re»t" and »ludy ihe 
articles on |)ro|)liylaxis until you think you know what those wnlen 
mean by a clean. Iiealtliy moulh. then go to one of them and lei hm 
show you just what he really does mean Ilien ol)*erve. aa ihcjr 
come to you. the mouths of your patients (your own and othcrt^ 
wearing fixed bridge work. When you have done this comcienli- 
ously for six months or a year. I challenge you to rei)ort the jMTcenl- 
agc of cases where the gingival tissues, adjacent to fixed bricjge 
work, in position one year or more, are in a satisfactory state of 
health. I greatly doubt if you will re|K>rt one per cent, of such cams 
in those bridges supplying more than one tooth, with the poMible 
exception of so-called "wash bridges " 

It IS to be regretted that many who ar*- ^killed in r; oal tech- 

nique arc unfortunate in their inability to reali/e the ' dctJiiU 

and constant alertness necessary to insure ase|)sis. .^ . ■ .'. root 

canal work calls for exactness in all details none can be neglecteci. 

A. — Any man who is to-day doing his root canal work under :i 
technique, which he would regard as insufficient for a laparoComy 
case, should re adjust it until it will meet that f'-^f brforr }\r tonrhrs 
another such case." 

It scriiis almost silly to take up our \aluable time in discussing tlie 
relative merits of a clean and an unclean piece of work in the mouch. 
but so many unclean yes, filthy pieces of work are being carried in 
the mouths of patients to-day. and so many more l>ring inserted r\rry 
day that it is impossible to let off the dentists who are doing it OQ 
any lighter charge than ignorance or indifference and either of ihe*^ 
is criminal. 

A patient recently presented himself in my office with a li\rd 
bridge, and asked me to remove, repair and replace it I A«kr<i him 
if he was careful .iboiil t le.iiiing his teeth, and he almost indtgnanll) 
replied that he brushed them three limes a day. and had just cleaned 
them prior to coming to my office I removed the bridge, and holding 
It with finger and thumb before the patient, lurneil it aboul so ihal 
he might see it. and then asked him !»» take it in his hand He 
replied that he dulii'l want to "and yet." I said, "you would kerp M 
your mouth a thing so filthy that you refuse to even hold * m your 
hand." I I' said he had no idea that it was in such a condition, and 
prmnptlv .u ( used the man who made it «if m.i'" - * '■ ' ^•* §*«• 
tiemeii. the serious thing about this is that the ♦ ^ .. ihcMJi 

some foundation Needless to *av. he is now wearing a rrmovcADic 
bridge 

/7ie dumhilHv of the iihuinicntx may l>e appropnatcty dw:u*»*^» 
at this point It requires no argument to |»rov^ that olher tKinr» 



6 ORAL HEALTH 

being equal, an abutment which can be kept clean will last longer 
than one which cannot be kept clean. 

If this is true in the average healthy mouth, it is imperatively true 
in a mouth predisposed to pyorrhea. 

Note A. — It may be laid down as a definite rule that in propor- 
tion as a mouth is predisposed to pyorrhea, just in that proportion 
is it necessary for the patient to have a piece of bridge work which 
can be readily removed and cleansed by him, and not only must it 
be able to be removed and cleansed, but the abutment remaining in 
the mouth must be so constructed that there shall be no projection 
beyond the line of what would be the natural contour of the teeth, 
to catch and hold food pabulum and other debris. 

We might advance further arguments, but sufficient has been 
shown to prove that other things being equal, a removeable bridge is 
more desirable than one that is fixed, and the fact that we have all 
seen fixed bridges which have been worn for ten or fifteen or twenty 
years does not in any degree lessen the force of the argument in favor 
of removeable work. Taking the stand then that removeable bridge 
work is more desirable than fixed bridge work, let us ask: Can as 
strong an abutment be made on a live tooth as on a dead tooth? For 
my part I have never yet seen the case where it has, nor can I con- 
ceive the possibility of such a thing. 

The advocate of the live tooth abutment immediately retorts that 
the assumption that a dead tooth is as good as a live one is a fallacy, 
and points for his proof to the startling number of devitaHzed teeth 
with imperfectly filled roots which show blind abscesses at their apices. 
Note B. — I might reply by pointing to the startling number of 
dead teeth having blind abscesses or fistulous abscesses and carrying 
abutments which were placed there when these teeth were alive. 
And a still greater number of these teeth, carrying single crowns, 
which fit so imperfectly at the gingivae as to cause inflammation and 
suppuration. If your Society has good luck, I trust that some one, 
before the season is over, will show you the pathological changes 
which take place in a vital tooth when used as an abutment. 

This immediately raises the question: Can teeth be devitalized 
and their roots so filled as to preclude the possibility of sepsis result- 
ing therefrom? I am ready to assert most emphatically that they 
can. I grant you that the technique heretofore followed and unfor- 
tunately still practised by the great majority of dentists will not insure 
against resulting sepsis. But that is the fault of the operator. It 
means, too, that a radical change must take place in the teaching as 
well as the practice of root filling. 

I will presently put on some lantern slides to show you that these 
roots can be filled, and if roots as difficult as these which I shall show 
can be perfectly filled, it is obvious that almost any other root can be 
perfectly filled. I do not make the assertion that every man can fill 
roots with this degree of perfection. Indeed, I am very sure that only 



OF^ AL HKAl. I H 

a limited few have at present the proper techinque at M"-" 
to make this possible. And of these who have the t' ,e, that 

are fewer still who have had sufficient exjKTience to that ihey grt 
100'' prrfrct root fillings; hut I do say that this work cmn be properly 
and perfectly done. 

Let us not concJemn a method because there are but few men 
capable of practisinj;; it if the results of that method may be iko%rfi 
to be better than some other existing method. Hut let us erKourage 
a high ideal in the minds of the profession at large and a desire to 
improv<' their techrncjur to the point where ihr^r i<lr;iN rn.^v K«- made 
possible of accomplishment for them. 

One part of this subject so intimately mvolves another that one it 
almost tempted to go on indefinitely touching on various phases ol 
the subject. I^ut I must mention at this point the neces^sily for a man 
recogni/ing his own limitations and giving his patients such service as 
lies within his own ability. No man should attempt a piece of work 
which he knows to be entirely beyond his skill, and if 5uch a pirce of 
work IS recjuired by his j)atient. then the patient should \yr referred 
to somebody who is able to properly perform the service required 

It is easily possible for a man contemplating the use ol certain 
teeth as abutments to first radiograph such teeth, and he can prob- 
ably then determine whether the filling of the rcx)ts is likely to be Mf% 
operation which shall come within the scope of his ability H he 
should find that the recjuired operation is beyond his skill, he should 
cither refer the patient for the root canal work to some one %*4k> can 
do it properly, or else resort to some other form of restoration. 




Buffalo Letter. 



By Habec. 



When Leuman Came to Town. 

NOW Leuman Waugh, of great renown, came to our burg from 
New York town and talked the wee' sma' hours away upon 
the subject of X-ray. With fllow of language like the brook 
and bait as fine as any hook that ever tempted wig'ly tribe to leave 
the deep where they abide, he told us in his way of ways the great 
importance that it plays in telling us the naked truth unless we go 
amiss, forsooth, and see the things that are not there or fail to read 
with proper care and mix the diagnosis up like oil and water in a cup 
and put your treatment to the bad because you were so sure you had 
the radiograph to prove it true instead of being up to you. 

Just where a fellow gets in wrong is when he puts dependence 
strong in what he thinks he's sure he sees and has a hunch that he's 
the cheese. He needs a course or two or three in scientific radiography 
before he should attempt to tell by sense of touch or sight or smell 
what means the signs that he beholds of human weakness it unfolds. 
If with each X-ray outfit bought the dentist should be duly taught 
just how the gosh durned thing should work, and put him next to 
every quirk, he'd stand a chance to make it go as well as bring him 
in some dough, and not a means of cheap John bunk that finishes in 
first-class junk. A school of radiography is just a plain necessity, 
and not until it's brought about should every dental roustabout, like 
Habec and some friends of his whose knowledge wouldn't stand a 
quiz, be given such a chance to bust a thing you buy on face and 
trust. 

But you should have heard our Leuman with acumen great 
illumine a topic of profound interest to every up-to-date dentist. 
From nine p.m. till one he speiled until our brains with knowledge 
reeled, and we were leaded to the brim with a desire to be Hke him 
and have an outfit by the chair to beard the abscess in its lair and 
to the cringing victim show, as we observe the telling blow, the inner 
secrets of his life and see how little bugs in strife have eaten holes into 
his jaw enforcing pathologic law. The awful tale is not half told, 
sufficient that they should behold the havoc wrought by cocci, germs 
and diplo, micro, staphlo worms possessed of zcologic terms that 
thrive in darkness, dampness, filth and dig away with startling stealth 
until they spread and radiate from wisdom tooth to orbit plate. Small 
wonder that the victim stare and offer up a silent prayer, for ills of 
lesser consequence have sent strong men from thither thence. 

Caught like the spider in the web, no chance has he the mesh to 
shed and to the dentist he must turn, at other times whose aid he'd 
spurn, but now he looms a saviour grand, the greatest man in all the 



OK AI H LAL I H 9 

land. Saint Apolonia be our ^uidr and fill m %^h our callmfr'. 
pride, so that deception we disdain and real profe^'nal men trr.. . 
Advaiila^r tlius to take beware, for in it liet a hiddrn toaie. and 
should hr hark to avarice he s|)oils his chance of future bliM. 

But with a history of each case and common sense lo V '-'••• ^;«ace, 
an X-ray picture may be seen to throw the truth u|)on ihr . and 

banish every bit of doubt by putting strepto to the root And of thr 
threat and Holy Writ oflirnrs we'er obliged to admit that one can 
find within its text the words to cover each pretext .i- - ' • - »n K» 
own desire his every motive to inspire. * I is thus we \-ray 

guide will make it plain or likewise hide the truth or falsehood as you 
will, and thereby fill your golden till, or be an instrument of good as 
every great discovery should. 

1 Ik- wonders of this marvelous boon as yet 'tis far too soon to 
comprehend its worth or foretell all its birth shall mean to myriad* 
unborn and e'en to thofe of hope forlorn. All this our l^uman did 
<'Xplain in graphic words and reasons sane, and when the owl cletk 
turned us out every shadow of a doubt amongst the faithful *ilten 
there had disappeared into thin air. and Billy Sunday would Ik* glad 
if converts in proportion had hit the fragrant sawdust trail %«rhm 
1 .eunian ended that great tale 

Sometimes we meet w?lh men well versed. i>erha|>s with too mucii 
knowledge cursed, on sul)jects that lo us are vague, and make iheni- 
selves an awful |>lague because they think they know it all from 
referendum lo recall. Not so with Leuman be assured, for all hit 
thoughts are well inured, so that expression is an art an' )• 

tence plays its part lew men can boast of such a gift. d 

by telling thrift, and with a presence great though small. : •»• 

ness that seems tall, he holds his hearers in a thrall and lhro%in about 
a mystic pall in whu h they revel in content until the thesis m well 
spent. 

' Iwas thus liie evening slipped away, and truth we say il to tliM 
day, a pleasanter we never spent, though off to slern mv nifht \uknt^ 
went without re<pect or sense or tact snoreil blitheU t' 
vincing fact Vt hv waste vour t»nie in telling more ar<l 
self a blawsted bore, for didn't I .euman up and go Ijv I f M' Td 
Torcnlo and spiel it all to you again with wondrous skill •> 
men? Though neutral when it comes to war. not to when I 
at the bar. so don't attempt to make a fuss. *rah for old Bu0a>a. .•« s 
one of u*; 

IhisIsOnUs 

Habec has had palaver, compliments. «oft-toap. iolhr Attd %mUt 
given him on the one hand, and censure. '">• 

precntions and exeeratMins hulled at him oi 
base never penetrated beyonil the epideri. : 

imsitor on Ohai. Hi Al.TH gave hm an awful |ar in making up hm 
letter for the November issue. 



10 ORAL HEALTH 

How would you like a headline like this? 



By Habec 
The Inevitable. 



We wouldn't mind being called The Invincible, The Impossible, 
or even The Irrepressible, but The Inevitable positively is the limit. 
To make matters worse, the editor didn't even apologize or send a 
Henry Ford expedition with a substantial peace offering. Possibly 
he may have intended it as a compliment, but we fail to view it from 
that standpoint. Yet, how easily all this injury to Habec's pride 
might have been avoided. Just a little more space between the lines, 
with a long dash to emphasize the separation, would have saved 
Habec an infinite number of heartaches and despondent hours. 

As an epitaph on the slab marking the lonely spot where we antici- 
pate spending much of our future unoccupied time, it might make 
quite a hit with the relieved relatives, but while the little red corpuscles 
are still playing tag from pole to pole at the rate of two minutes per 
lap, within the sacred precincts of our cutaneous covering, we refuse to 
be The Inevitable. However, we forgive Wallace this time, but here- 
with serve him with the warning that should it happen again we shall 
demand that our salary be doubled as the only commensurate balm 
to our ravished feelings. Perhaps, on second thought, we would not 
deplore a repetition, as we have successfully retained intact the one 
goose egg already received in exchange for our numerous intellectual 
outbursts, and a congenial consort no doubt would serve to make 
G. E. No. I more contented with its lots. And then — happy thought 
— we might awaken some bright morning to find a brand new family 
of little G. E.'s. After all, in view of such glowing prospects, we 
have decided that the injury was more imaginary than real, so we 
withdraw the complaint and apologize to the editor. 

Higher Mathematics. 

Which would you prefer, to take a man at his face value or at the 
value of his face? It's rather a cheeky proposition and may be 
viewed from diverse angles, as the photographer might say, but never- 
theless there is a thought back of it that may be worth uncovering. 

The face value of a man may qualify him for any of the higher 
stations in life. Should it register below a certain point, he must 
depend on the value of his face. The face value of a man may be 
subject to discount, like his note at the bank, or it may draw interest 
instead. The value of a man's face often places him in his proper 
environment without effort on his part. Habec once knew a man 
who took pride in having it said of him that he had the best funeral 
face in the town, and in consequence he presided with great unction 
and dignity on the driver's box of the village hearse. A fourth of 
July celebration or the county fair was always shunted in favor of 



OK AL HLAl. I H || 

the chance tu display the value of his face. -^«wf^i mf %re find A 
fellow who is two-faced, but this seems to bisect its value rather than 
double it. At any rate, so long as each has but one poor old muf 
to trade on. we believe it is better to estal>li^h a good face value, and 
the value of ones face will come tagging after. 

A Bt OR Not a Be. 

When is a B not a B? Don't jump: your're not ^tun^ It wn'l 
thai kind of a B, 1 he one we refer to is harmleis and a {•ftf-" » 
gentleman. For instance, in the word "subtle," it is pr«in«.»u!. 
"sut'l " Now. what is the sense of sticking a B m there to fool j 
fellow and cause l[i<*s<' foolish remarks Iliere is a lot of the !.\ 
wagging the dog sort of business in orthography, and we begii • 
feel the symptoms of an acute attack of esparan/a Aspirm usrti ; 
be given for such complaints, but now that the Kaiser is taking it ail 
we must suffer in silence. 

But speaking of "sut'l." \ i.ibec had an X ray «)f it sent him from 
Nebraska the other day. I he dentist remarked that it was tak*-" 
to locate an abscess over one of four teeth, ami that the only ^'^ i 
he could account for the wire fence in the picture was that the |>alirnl 
was a farmer and he must have been thinking of the hog^ Il>e 
teeth were so sull as to be invisible, and the whole thing looked a* 
though the e.xperl radiographer had taken the farmer's whiskers in 
stead of his teeth, for it showed only a maze of scraggly lines runninx 
in all directions. Surely the mysteries of the X-ray are |>a«t finding 
out. 

I m I I Ki OF Boyhood. 

At last F'raiik D.iymeiil has yielded to the unseen po%«ref ol boy- 
hood's lun- .tnd has returned to Toronto to pracltsr his y>rofr< t i or 
I \r lias taken the practice of Dr. George Gow. who it patr 
serving his country at the head of the Canadian .Army Dental I 
He expects to continue the practice during I^ C*ow's eiifoTcr\j 
«ibseiue We congr.iUilate I or onto in ha\ing acquired die of 
BulfaN>'s best piaclitioners. and a royal good fellow in e%ery rr« 
Habec had ilu satisfaction of enjoying Dr Da\menl*« fneinl' 
and feels a gieat personal loss in being depfi\ed of almoiC dAU> 
enjoyment of this privilege He was a meml>er '^ ''-- Dental Advis- 
ory Board of the Department of Health of 1. and wa« %rtv 
active in the management of our free dental clinics, and we •f 
him as a co-worker He was an active r- of R ' a 
male vocal s<xiety. the C<uido Chorus. ari*i iv -•' ^-aI 
fM>sition in our city He has endeared lutio. ,[ t aiKl 
enjoyed a large clientele that is loth to part %*ilh him Ma\ %wrr«» 
attend him 

Best wishes to our readers for 1^16. 

Hahm 



Management of Children and the Treatment of 

Their Teeth. 

Clarence R. Minns, D.D.S., Toronto. Dental Department. 
Sick Children's Hospital. 



IN complying with the request of your worthy editor for an article 
upon the above subject, I have found it difficult to confine my 

article to any reasonable length, for this subject is such a large 
one and one of such great interest to me. 

In the first place, to be successful as an operator with children, 
it is essential for one to love children and have a deep and sincere 
interest in them and their work, play and thoughts. Besides these 
two great essentials, he must be possessed of an abundance of 
patience and kindness. The child must be made to feel that that 
which is being done for him is for his benefit, and that you have his 
interests at heart. Therefore, a few minutes spent in explaining the 
use and the working of various instruments and appliances, as well 
as in answering the questions of the child with an inquiring mind, 
is time well spent. 

One of the main objects in children's work is to get the best 
results with the least effort. It is always wise to be frank and honest 
with the child and never to deceive them. Choose your operations, 
commencing with a simple one, and one which has little or no pain 
connected with it, if possible, reserving the more difficult and slightly 
painful operations for future sittings, when the child will be less 
nervous and have more confidence in the operator. 



[Since the above article Tvas written Dr. Minns has passed over 
into the Great Be\)Gnd. The late Dr. Minns was one of the most 
promising members of the dental profession. He was head of his 
class each year of his four-year course at the R. C. D. S., and since 
graduation was demonstrator at the Royal College of Dental Sur- 
geons and in charge of the Dental worl( at the Hospital for Sick 
Children, Toronto. The manuscript was written for ^'Hya Ya^a,'* 
the students' journal of the R. C. D. S., to whom Oral HEALTH 
extends thanks for courtesy of publication. Clarence Minns was 
appreciated by the medical staff of the SicJ^ Children's Hospital no 
less than by his college associates, and will long be remembered for 
his enthusiastic and keen devotion to every worthy effort for the 
advancement of his profession and the uplift of mankind. The late 
Dr. Minns proved to be of almost too fine a mould for this strenuous 
work-a-day world, and made the mistake of not giving himself the 
relaxation and rest that his private practice and other activities 
seemed to demand. — Editor.] 



ORAL HLAL I H |> 

Again. It IS advisable in moft casci to treat the child in the abicocr 
of his parents, for with but few exce|>tions. children are much more 
easily handled and will stand more when alone with the dentMt. 

Ascertain upon tbr first visit of the patient if there hat been any 
toothache. If so. remove the cause and slop the ache, if at all (xja- 
sible. Ilien proceed with prophylaxis. In case of no |>ain. I invah* 
ably perform prophylaxis as my first o|>eration. thus |>roving to the 
child that the dentist is not such a drradful man as his aunt, hu big 
brotlier or fister. or some oilier ihouRfitless person has pictured him to 
be. I hen, if the child is old enough to understand, explain to hm 
how to properly use a tooth-brush and when to use it. If the child 
is loo young for this. I explain to ils mother how she can keep the 
mouth clean. 

I he general order of procedure is as follovss: 

1. Pam. 

2. Pus conditions 

3. Vital teeth nearing exposure of pul|>s 

4. Putrescent conditions. 

5. Minor cavities. 

6. Kxtraction. 

As a general rule. I leave the extraction till the last sitting. unlcM 
some other condition contra •ndicates this In fact, for some |>atiailS 
it IS much better to get the extraction over at the first *ittiiiL» .%n«l fK«^, 
W'lh the most dreaded operation off my hands. I can | Mt 

all other conditions in a clear field devoid of all unheahhy roots. 

Just here, it might be wife to mention some inlerr*li' ' 'to tkiost 
the reasons for preservation of the deciduous Ireth I j . >..r time al 
the advent of nu-dual and dental inspection of children, little was 
known of their physical defects, and great was the surimse when rt 
was found that a large percentage had numerous ' such at 

defecti\e vision, defective hearing, enlarged l«>n«'U. .».: i- ? ^^ 

feclive teeth Of these defects, the last three are the n; ' - 

I'xamination of school children the world over sho^*** that as a rule 
between ninety and one hundred |>er cent, have deferti%e terfh I ^ 
bring these statistics closer home, n lesl rxaminal'on of two tchooo m 
I oronto g.iNf the following inlerrstmg facts: 

PeTe«»« 

Numbei of children nerthng treatment '* 

Number of cavities |>er child 

Number of defective teeth |K*r » hiM • "*^ 

Numbei of chlldi'H h.»\inu .»b*« r*»rs 4 1 

Irregular teeth *• 

Power of mastication impaired 
I he above results lead us to wond- 
conditions, aiul here we are confrontetl ..;..:..... 
parents are entirely ignorant of the xalue ol the l *» 

Some believe that thev must decay before the i^etmaneni • 



14 ORAL HEALTH 

can erupt, while many others cannot see the advantage of having 
them attended to when they will be lost so shortly. 

1 he preservation of the temporary teeth is of great vital importance 
to the child for the following reasons: 

I. It is not wise to let the child suffer with toothache, for it causes 
nervousness, chorea or St. Vitus Dance, and sometimes vicious and 
criminal tendencies, along with dullness at school, can be directly 
traced to the condition of the teeth, and upon treatment and repair 
of teeth, these conditions are overcome. 

II. There is no other period in life when an individual needs every 
ounce of nutrition obtainable so much as in childhood. For the 
child has to double and treble his weight, his body, mind and moral 
fibre are developing, and if his masticatory apparatus is impaired 
by numerous cavities in the teeth, he cannot be expected to get all 
the nutritional value out of his food. 

III. The mouth being the entrance to the body, through which ail 
food, drink and some air passes, therefore an unclean mouth must 
contaminate all food and drink. For the various cavities contain 
bacteria and their products, along with decaying food from previous 
meals, as well as the pus from the so-called "gum-boil." This is 
mixed with the food and carried on into the stomach, which is over- 
taxed, and we have as a result, indigestion, anaemia and constipation. 

The epidemics of children's diseases, such as measles, chickenpox 
and scarlet fever, bear a direct relationship to the conditions of the 
children's teeth, for the decayed teeth form an admirable lodging 
and breeding place for germs. It has been found in numerous cities 
that epidemics of these diseases can only be stamped out by having 
every child affected, compelled to have the teeth and mouth put in a 
healthy condition before return to school. 

IV. The early loss of the deciduous teeth causes many irregu- 
larities in the permanent teeth, as does also the too late retention of 
these deciduous teeth. If the pulp of these teeth remain intact. 
Nature's plan of exfoliation is very thorough, but with the loss of 
the pulp, the resorption of the root ceases and the tooth is consequently 
retained too long, thus producing irregularities in the erupting per- 
manent teeth. 

THE TREATMENT OF DECIDUOUS TEETH. 

Cavities in Vital Teeth. 

The treatment of cavities depends to a great extent upon the age 
and the general health of the patient, as well as on the care of the 
mouth. Generally speaking, the six anterior teeth do not need to be 
filled. If decayed, the decalcified tissue is removed thoroughly with 
an excavator or large round bur. After complete removal of the 
decalcified tissue, the teeth should be dried with alcohol and the 
cavities painted with a solution of silver nitrate, about 4 per cent. 



OR A I. HKAL I H 15 

In very rare cases, I fill these cavities with white copper cement. 

followinj? the above trralmrnt Just here I would like to explain thai 
in doiriK any operation. I always explain as well as pOMlble to my 
little patient wfiat every irjstrument is for. and how I use it, and %tffturt 
it does I allow them to handle the instruments whenever iifiJlU 
Now. in removing decay from a cavity. I invariably start uith an 
excavator, and then I explain that I am going to do just the same 
thing with a round bur in the engine, only that it does it more quKkly 
and more thoroughly In this way I never hesitate to use tKe engine. 
and it is very seldom 1 ever find a patient that I cannot i»r any ol 
the ordinary instruments and appliances used for adults 

1 he deciduous molars, where the cavity is shallow and tooth to 
be exfoliated shortly, it is only necessary to remove the decay and 
paint the cavity with silver nitrate solution. In deej>ef ca\itir^ .trid 
where the tooth is to be retained for a couple of years follow 
above treatment, the cavity may be filled with black coj>f)eT cement 

I'rratmknt of Rxposf.d Pulps in Vital Tfxth 

In a great majority of cases, unless the pulp is loo extensive!;. 
exposed. I invariably resort to pulp-capping First carefulU ex 
cavate the decalcified tissue and dry cavity, cauterize wi'^^ • ' rt,..' 
I hen cover the exposure with a paste of oxidi/ed /inc . 
cloves. Next take a small piece of pa|>er just large enough to coirer 
the floor of the cavity, mix a thin mixture of oxy-|>hos|>hale ol zmc 
cement and |ilace it on one side of the paper and place the cencfll 
side down in contact with the ca\ity seal, gently tapping it to place 
so as to avoid pressure. Now the cavity may be carefully filled ^*:tS 
copper cement. Now if the pulp should die in one of these case«. *nt.\ 
we have the patient under our care continually, we haxe a fawlv ea»\ 
condition to cope with; an easier one. to my 'd' i than what the 
extirpation and removal of a vital pulp from a us tooch !»> 

In a very few cases, however, it is absolutely necessary to eitvpale 
tlu- pulp, and there are two methods o|)en in most case*. The 6m 
one IS reasonably safe, but n rather slow and difficult o|Mvation i he 
second one is fairly easy and (|uick. but rather danprr.uM unlrM one 
remembers well the prospecti\e dates of ctmiplete c.\ and ol 

commencement of decalcification of the roots of tefn|x»ary teeth 

We will first consider the safe and most reliable methotf. the u*<- 
of Phenol This is a somewhat slow and tedious operation, and ^o* 
erally re(|uires from three to h\e sittings At the linl sitting, tcal n 
Plicnol in contact with the pulp after having enlarged the empoiurr 
At ih. next sitting, after from three days to a week. « If « ' 
tint the pulp can be removed entirely from iV nber ii\c:\ i 

Phenol into the ro<M canals, using pressure v .»w ^^^^^r^^r a 

leave foi three or four days At the third silting, usual! ■ 
manipulating the broach, the pulp may be all lODOVcd. akhoufh « 
mav take a couple of additional sittings in some casr* 



16 ORAL HEALTH 

The second method of procedure is the use of a very limited quan- 
tity of arsenic, and as these teeth are very susceptible to its action, 
it should never be left more than twelve hours. In connection with 
the use of arsenic, it is necessary to remember that in temporary 
molars, generally speaking, the roots are completely calcified at the 
third year and decalcification does not commence till the seventh or 
eighth year. After twelve hours the pulp can usually be removed 
with barbed broaches. The canals are dried out and flooded with a 
solution of silver nitrate. The roots are then filled with a paste of 
calcium phosphate and creosote. The cavity in the tooth can then 
be filled with copper cement if it is not too large. 

If the cavity includes two-thirds or more of the crown, the crown 
should be ground down, leaving a saucer-shaped cavity which is 
stained with silver nitrate. 

Putrescent Pulps. 

Teeth with putrescent pulps should have the canals thoroughly 
cleansed and a mild treatment of fomo-cresol sealed for a few days. 
If the conditions are favorable at the next sitting, the canals should 
be dried and stained with silver nitrate and the cavity filled, if not 
too large, or the crown ground off and the remains painted with 
silver nitrate. 

Abscess With Sinus. 

All decay and pulp debris should be removed and the sinus cauti- 
ously washed out with sterile water, followed by a little oil of cloves 
or creosote, using pressure with raw vulcanite to force it through. 
The tooth should be sealed up and left for three or four days, when 
in most cases the sinus will have healed, for these cases respond very 
readily to treatment. Mechanical and medicinal treatment should 
follow, and when in a healthy condition it should be similarly treated 
to the other pulpless teeth. 

In extracting for children, it is only wise to extract teeth which 
are loose due to the absorption of roots, or those in which the pulp 
having died and the permanent successor can be detected as forcing 
its way up to place. Also any case in which severe abscess contra- 
mdicate further retention. If only loose teeth are to be removed, 
there is very little need for an anaesthetic, although a local anaes- 
thetic can be quite nicely used. In cases of extensive extraction or of 
bad abscessed conditions, somnoform perhaps gives the best results. 

PERMANENT TEETH. 

The treatment of permanent teeth for children, except in very rare 
and much neglected cases, resolves itself into the treatment of the 
six-year molars. This tooth, the most important in the whole mouth 
at this time, is perhaps the worst neglected and most frequently lost 
permanent tooth. This is due to ignorance on the part of parents, 
and sometimes due to a mistake on the part of the dentist. It is 



OK AL HKAL I \\ 17 

allowed lo decay qiiitr frequently under ihe tmpfeMion that it m 4 
temporary lootli 

I he position in which it erupts, hrhind the »«cond lefn|)orAr> moUr. 
and the a^e at which it a|)pear5, are the two «ure^ guicie^ a» lo tfs 
idriitily. I he ^rrat imp<>rt«ince of this tooth w due lo two functiOQft 
it performs: 

I it provides a masticating surface during the procnt of thcdcimf 
of the deciduous teeth. 

2. it maintains the horizontal and |>er|>endicular relation of tht 
jaws at this time. 

If children are brought to the dentist regularly, commencing at horn 
two to three years, and the dentist sees them thereafter after every tii 
months, very little is necessary to he done to any of the teeth, and 
especially to the permanent ones; but unfortunately usually the fvft 
time a child is brought to the dentist it is because of toothache, and 
quite frec)uently because of a toothache starting in the first permanml 
molar. Now our first concern is as to the involvement of the pulp, for 
none of the permanent teeth have their roots completely • »'• '"^ till 
about three years after eruption (excepting the cuspid). .» ith of 

the pulp before completion of the roots means that thev are never com- 
pleted, and consequently the tooth is lost in a short while 

In almost all cases where the pulp is but slightly in\ol\ed. '-•' 

to resort to pulp-capping, and in this way retain the pulp a* i-'f^; .1* 
possible with the hope that it will remain alive till the roots are com* 
|)letely calcified. A temporary filling may be put in the tooth and the 
patient advised ih.il upon the least return of severe pain from thai 
tooth, to return and have it attended to. 

If. however, the pulp is exposed to loo great an extent, it musi be 
devitalized and removed It is wise in this case not to leave ihe 
arsenic more than 24 hours at the most, and to remember in remonof 
the pulp and filling the canals, that the rtx^s are not ' ^'' ^---I— d 
As a root canal iilling in these cases. I have used > '^ 

zinc and creosote, along wiih gutta-|>ercha cones very carefully in- 
serted Iliese teeth are almost invariably lort in the coune ol a 
short period of time 

Occlusal cavities ni>t involving the pulp *li.«ii!.f br miaiW to HicJude 
all fissures if at all possible, but with somr ren < m only 

wise to remove the decayed area 

Proximal cavities should almost inNanably l>e carrKd colo ihr 
occlusal surf.u e. but this (Jepentls on the patient 

( )ften before the fissures in a molar be\ ome decayed, they OMV 
be healed with a mild solution of silver nitrate, dried mn6 ^ ^^^ 
cop|>er cement s(|uee/ed into ihem. thus |Heventing decay ir •<- 

live fissure 

In closing this lalher lengthy artKJe. I %%ish lo slate that lb* 
above methods of treatment and statistics are not inlef>ded lo he 
original, but ha\r been learnt from the pergonal instTuctKW and 



18 ORAL HEALTH 

articles of the late Dr. Doherty and of Dr. J. A. Bothwell. I have 
been putting them into practice almost constantly since I graduated, 
and lately most extensively at the Hospital for Sick Children, and 
I have found them to be remarkably successful. In my work at the 
Hospital for Sick Children, I have had to w^ork for children from 
seventeen months of age up, and I don't know of any work that is 
more interesting and enjoyable than working for the kiddies. 



Dental Work in Toronto Hospitals. 

IN the Monthly Report of the Department of Public Health for the 
City of Toronto, an interesting account is given of the work being 

accomplished in the hospitals of the city. 

The work in the adult clinics is growing very rapidly. At the 
General Hospital the work is really being transferred, as so many 
patients are asking for treatment. At the present time the appoint- 
ments have to be made four weeks ahead. This is a great handicap, 
as there is always a great deal of emergency work. 

In the Western Hospital almost the same condition exists, and is 
growing worse all the time. 

In order to overcome this crowding it will be necessary in a very 
short time, possibly the first of the year, to have the adult clinics for 
all day. At present the clinics run only in the forenoon. 

Several interesting cases of arthritis have attended the clinics for 
treatment. One lady, a city order patient, had been in the hospital 
nearly three months, practically a cripple in bed. After attending 
the Dental Clinic and having her mouth and teeth made healthy she 
showed signs of marked improvement almost immediately, and in 
four weeks' time was able to go home, almost completely cured. If 
it had not been for the Dental Clinic she would have been, in all 
probability, in the hospital yet. Several similar cases have been 
presented in the last month, and the results obtained are very inter- 
esting. These cases tell the real value of the Dental Clinic in hospital 
work. Such a clinic is a great asset to the hospital and to the city. 

A large number of patients are in poor health, purely because 
they have unhealthy mouths, and after their mouths are made well 
they usually recover their health rapidly. Many physicians, and 
others too, realize that a great many of our ills come from unhealthy 
mouths. As a result of the prompt recovery of many patients after 
dental treatment both the patient and the city are saved much expense. 



Important .Announcement. 
Paktial Dknturls and Kkmoveablf. BRirxirwoRK. 



NO more striking object lesson is needed by the obt^ving denial 
practitioner, of the frequent failure of **ofdinary" partial den- 
tures, than the diseased conditions (caries, pyorrhea, abrasion. 
etc.) that frequently result, sometimes, indeed, presenting from even 
the better class of dental office, f-xceplmg j)ossibly the question of 

the root-canal-septic-foci (|ue9tion. there ts no 
bigger problem in dentistry to-day than thai 
of the design of a simple. com(>aratively mex- 
|)ensive. removeable. non-irritating. sanitary. 
mechanical efficient, and unobtrusive rrUora- 
tion of the partial denture removeable t>ridu'* 
ivpe. 

ITie construction of this type of rrslocalion 
may. and should be. well within the reach ol 
llu" average and even near average pcac 
titioner and his faithful and efficient co- 
worker the laboratory man and. most im- 
portant of all. within the reach of the great 
iiMss of the semi edentulus public. 

I his important subject will t>e thoroufhJy 
covered in a series of three articles to appear 
in the March. April and May issues ol C)raL 
HlAl.TH. and fully illustrated with dra%«ing«. 
photogiaphs, etc . under the he.uling of "Partial Dentures," by Dr 
W. E. Cummer. Professor fVoslhetic Dentistry, the Koyal College 
of Dental Surgeons. 1 oronto. Iliis material was originally pre- 
pared for the meeting of the Virginia State Dental Sxiel\. in Kich 
mond. Va.. during November. 1^)15. It has since l>een prrvnted. 
with alleiations and addilu)ns. before the Montreal Dental Club, 
on Decembri I. DIS; the Toronto Dental Sviety. Decrml>ef 16. 
1915: the Hamilton Dental SKiely. Januarv 12. 19|6. .x " lie 
given before the I irM District Dental Sh lety. New ^,^k x ,I)r. 
i'ebruarv 7. \^)\h, the .Alumni .Asstx iali«»n of the Dental Drpail- 
ment. I^uffalo University (in clinic form). Buffalo. February 19. 
I*) If), and the meeting of the Michigan Slate Dental Society, to be 
held in Detroit during April. 1916. 

The (nitstaiulin« feature m this series of artifir- -- •**" **^ "tiiove 
able design, reducing the culling oi terlh to a ».e|efOll 

metal construction (in no case touching the gingival margin or reach- 
ing beKnv the free margin of the gum), with sin 1 a* little 
possible expense of lime and materials Princi|>ir?. L>f-i!r^ed to be 




20 ORAL HEALTH 

largely new, are introduced, notably those described under the cap- 
tion of indirect retention, the latter chapter which no dentist can 
afford to miss. The series is written with the sole object in mind of 
service to the public through the dental profession, and is made as 
practical and free from complexity as lies within the power of the 
writer. 

Concluding the series is a synopsis setting forth in detail the steps 
in simple and difficuh specific case involving upper and lower, con- 
structed in the most careful and scientific manner, using Professor 
Gysi's principles of anatomical articulation and involving principles 
of direct and indirect retention. Illustrations will be obtained from 
photographs of models prepared by Mr. C. L. Daly, of Toronto, 
whose assistance has been invaluable to the author in the preparation 
of that branch of the paper. 



Russian Women Dentists. 

IN view of our growing interest in Russian affairs, a note on dental 
conditions in that great Empire may be opportune. In Russia, 

dentistry is regarded as one of the best professions for women, 
who are estimated to constitute 90 per cent, of dental practitioners. 
The chief school is the Dental College at Petrograd, which has 600 
students, less than 5 per cent, of whom are men. There are also 
large dental colleges at Moscow, Odessa, Kiev and Warsaw. Be- 
fore entering upon the three years' dental course the student is re- 
quired to have matriculated. The fees amount to £20 per year, and 
the State diploma costs £2, a license to practise being only granted 
on proof of qualification. 

The first year's studies are devoted to mechanical dentistry; in 
subsequent years the student does clinical work from 10 to 5, and 
lectures follow until 9 p.m. Examinations are held every month. 
The lectures at Petrograd number about twelve, and come from the 
Imperial University Faculty of Medicine, while the ten demon- 
strators are chiefly women. For both medicine and dentistry fees 
in Russia are considerably lower than in this country, and hours of 
work are also longer. Men seem to prefer to enter the medical pro- 
fession, and it is said that even in the capital city of Petrograd the 
men dentists of standing do not number more than half a dozen. — 
British Dental Journal. 



I he Canadian Army Dental Fund. 

TUi: following subscriptions have been rcccivrd Uv li.r Ir^.. . 
I)r C V Sndgrovc. 105 Carlton St. roronlo. *incc th. la^t 
report in Oral HF.ALTfl. and appended is a complete lUle- 
menl of Receipts and Disbujsements to December 31. 1915: 

I'rMvioii-,|> acknowlrilKiMl j I . 

in Oral H«'Hlth $2.3:{r> l:{ F ^22 

Alberta. ^ L«'rm.ux. \! Stt 

Oalicary Dental (Mab $25.00 c. F. NlchoV v '- '^ 

Ontario. A. T 

Wlokett & Smith. Toronto. ^ ' 

135 Setj« of Te»»th. ^ ""^ " 

J. G. O'Nell. Fort Willlani . . .$ 5.im) ^ "; ^ 
C. A. n. Kenn.Mly. Ft. WHllam 5.00 , ^ ' 
J R. DoyU. Port Arthur .... fi.OO ^^^^^' 

V. H. Wauk'. Toronto 10.00 , 

GeorK»* W. Kenn«»<ly. London. 10.00 IV 

Colon STiilth, London 5 00 . ' 

L. L itennv. j 
QuebjH-. A. I^r!-'- - - 

J. S. tbbotnovi. Montrt'al $50 00 ^' *• 

W. G. Tliro.<by, M<Hifr.«aI 5o!oO ^' *^ ^ 

D.J. Uerwirk. .Moiitnal 25!oO *■'• ^^' 

Vy. J. ^ A K CriU^.M. .MontreaL 2r>.00 '" ' * 

F. O. HiTiry. Montreal 25.00 ^- ' .r.»i.k.. 

T. D. MciJreKor. .Montreal ... 25.00 ^' ** *' 

C. F. Morrl.Hon. .Montnvil '-. m) ^- ' '' 

O. W. OI1V.T. .MoMtrral . j «• « 

J. W. Shaw, Monfff.al 25.00 '' **"' **»^ 

So<lei»' (r<)(lf»iiioioKle, Mont '•<•" '• ?^ 

real >o L. T I i^i . . 

n. T. Thrcwby. Montreal o ^ ^^' ^' " ^••'' 

F. A. Steven>on. .Montreal -^ ^'' 

F L AVIIkins»»n. .Monirenl :«,»<> n«*niii . 

n II K.-rr. .Montr.'al i . .mi ^ ' M.miI'.im 

F 11. 11 Baxter. Montreal luoii '* .\ N» jw 

F. \V. IlrowM. .Moniri-al 1" «■ ^^' ^ • ••• 

J^ R. Ilrown. Montreal S» kjiirh«wi»n 

E, T. Cbneiantl. Montreal l y, ,• r.ur;.t..- .» 

J. 8. Dohan. Miinfri>al ... I'lnt w w }•,•..., i,> 

K. ?>nbeiii|. M I,, ,.ii i; I 

R. K. Kill. .It. V .al ... 1 Ml j^ I 

J. <i. <;ariln«T. Montreal . . i p |, 

J. <i. A. (iendrean. Monlre.t. i p j. >^ 

A. C. Jack. Montreal I I' \V w 

n. Lti:ht.mon<>. Monirfal ! • |»r *» 

A. W. .Mr('N'll«!u|, MtiniitM: i • J .\ ^ 

Alfr^l M 1. Monirf»al. lo ik» \\r « 

J M<»lin. N: »1 . . l.t.Mi y I ,. .^ 

J M Sprinirle. Montn-a • ^' \V I 

T. I). Tan.M»«y. .Mf ■ • F H 

W. W. \Vat?ton. \! U \ 

H. V. \' v .,..., ^ 

T. Au. . ,: > '; \' ■* 

G. S. Armii.iic'v Montiin' w »t 

A. M. Avon.son. Monti iNtl 

A. lUMtuchamp. Montreal 



22 ORAL HEALTH 

New Brunswick. Dr. Otto Moore, BathuTsit ... $15.00 

W. Bourbonnais, Montreal .. 5.00 Dr. R. B. Hagerman. Centre- 

W. E. Bovce. Montreal 5.00 vill© • • • • ••••;••• ■^"'^ 

J. Bovne," Montre-al 5.00 Dr. J. D. MacMillan, New- 

Stanley Burns. Montreal .... 5.00 oastle ..... . • ••••••-•••• .^'^^^ 

J K. Clearv, Montreal 5.00 Dr. A. H. Merrill, St. John^ . . 10.00 

E. A. Cleveland, Montreal . . . 5.00 Dr. J. D. Maber, St. John . . . 10.00 

E W. Charron, Montreal .... 5.00 Dr. F. C. BonneW, St. John . . 5.00 

C DePencier Montreal 5.00 Dr. G. O. Hannah, St. John . . 5.00 

Leo Doran, Montreal 5.00 Dr. C. F. Gos.ham, St. John . . 5.00 

H V. Drulr, Montreal 5.00 Dr. Otto Nase, St. John 5.00 

M. Gold, Montreal 5.00 Dr. W. P. Bonnel'l, St. Johoi . 5.00 

H. S. Gross, Montreal 5.00 

W. G. Ke'n.nedy, Montreal ... 5.00 *o .oo oo 

G. H. Kent, MoTitreal 6.00 Total Suhscriptions . . . .$?>,423.2S 



TREASURER'S STATEMENT 
TO 3 1st December, 1915. 

RECEIPTiS. 

Received! by Dr. Snelgro've $3,120.01 

Received by Lt.-Col. Armstrong 303.27 

Bank Interest H-Ol 

$3,434.29 

DISBURSEMENTS. 

To T. Eaton Co. for Operating and Laboratory coats, 

cottonwipes, and special s'upplies $ 831.12 

To C. A. D. C. Overseas — 

Per Lt.-Col. Armstrong 308.27 

Per Major A. A. Smith 1,500.00 

Printing 80.50 

Secretary's Office 6.09 

Treasurer's Office 1-80 

2,722.78 



Balance on hand as per Bank Account $711.51 



A Fifty Dollar Letter. 

AT the last meeting of the Toronto Dental Society, Dr. C. E. 
Pearson read a letter he had recently received from Captain 
Mallory, C.A.D.C., who is stationed at Salonika, Greece. 
Upon the conclusion of the reading there was a spontaneous call to 
"pass the hat," with the result that $50.00 is placed at the disposal 
of Captain Mallory, to be spent at his discretion, in helping neces- 
sitous cases that come under his notice, and thus in a small way 
relieving some of the distress in the war zone. 



OF^ AI II I.A 1 I H 23 

Captain Mallory's letter follows: 

"Salonica, Greece 

**No. 4 Canadian General Hospital 

"(University of loronlo) 

•Dec 5lh. 1915 
"My Dear Charlie. 

"I am sure if you wcrr out hrrr you would fully be repaid for any 
trouble you could lake in giving these fellows any comfort \^ ' •''•-♦^. 
I heir thanks and appreciation are fine, and it is really %■. lul 

how good, decent felKnvs they are. and what they have to put up 
with, sleeping out all night and no supper are common things The 
money that you so kindly sent me is more than getting \alur out 
here. I gave cigarettes to some, some cheap nole-pa{>er to %«Tilr 
home with to others, some Oxo soup (hot), and to one fellow I gave 
a pair of rubbers, and another fellow some bread I tell you I take 
off my hat to the l^ritish I omniy as we see them here Ilie I rnlh 
Division came here from the Dardanelles and went up to the frool 
with summer clothes, and last week we had three days and nighu 
of I 5 of frost It was 15 above zero in my tent, and we have 600 
frost-bites in the hospital, and yet these fellows do not c i, but 

want to get well (juickly and back to their lines llie li.n.-ii ^>(Bcet 
is another fellow, but the 1 (Jinmy is a real man. and an> thing I have 
he can have. 

*' I he hospital is situated on a slight slope four miles from Salonika 
and is in a really good situation Iliere is not a tree in sight, but in 

whatever direction you look you see a mountain <'f ^r We 

highest IS Mount Olympus the Greek God it i^ .» .\t> miin 

away and being I ().()()() feet high, but some days with the tun sKming 
brightly on it you think it is only a nice walk \l\e miow on il» lo|> 
IS nearly always visible We are on the main railroad fomg lo 
Serbia, and also on the wagon road We are a clearing hoipilal. 
We clear to hospital ships. We had I . ^K) on day l>efoce yeMrrday. 
and to-day a ship came in anci we got rid of I'iO In one defwl we 
are going all day long; we see from forty to sixtv |>alienl» a day. 
and do mostly amalg.im and extraction I o day wr rttracted wib 
local anaesthetic sixty eight teeth, eight amalgam filling^, til re- 
paired dentures, three pyorrhea cases, and I can auure you ihal » a 
full day's work Vt'e have a large workroom lo %%*Ofk in. and iSe 
light we use is the li«ht that comes through the can\as. ar- ' - »-•. •^'• 
sun comes out it is line, but I do not think we will br .^ 
it next summer without a fly. and that would block the light CMe 
day the wind came and blew George's cabinet over h» i^lient and 
himself and broke a lot of stuff, but such is life in a big cnunlrv I 
received the maga/ine you sent, but we \\a\e onK h.td !\*o m^ib 
since we left i .ngland seven week> ago. 

'We are going back by I^erlin and see if we like the d H-*' ^ 



The Late Charles Edward Sale, D.D.S., Toronto 



IT is our sorrowful duty to record the demise of Major C. E. Sale, 
of Goderich, a member of the Board of Directors, Royal College 
of Dental Surgeons of Ontario, who has died a war hero in 
France. Major Sale's name is the first to be transferred from the 
Oral Health Active Service Roll to the Roll of Honor. 



A Fellow- Practitioner's Tribute to the Late Major Sale 
L. M. Mabee, D.D.S., Goderich. 



MAJOR CHARLES EDWARD SALE, of Goderich, died 
in Flanders on Monday, January 17th, 1916, in an ambu- 
lance while being taken to No. 5 Base Hospital, after being 
wounded in the leg. 

Major Sale had just been back to the trenches about three weeks, 
his absence having been caused by previous injuries. He was 
attached to the 18th Battalion, under Col. Wigle, and trained six 
months in London before going overseas last spring. 

The late Dr. Sale was born in London township in 1878. He 
attended the London Collegiate Institute, and afterwards went to 
Sarnia in the office of Dr. Homer Kinsman as a dental student. 
From here he entered the Royal College of Dental Surgeons of 
Ontario at Toronto, graduating with honors, and finally locating in 
Goderich. For the past twelve years, while practising his profession 
in Goderich, he was much esteemed by his fellows in the profession 
as well as by the public generally. 

He was a member and Past President of the Menesetung Canoe 
Club, a social organization of the town. He was a Past Master of 
Maitland Lodge, A.F. & A.M., a member of Huron Chapter, a 
member of St. Elmo Preceptory at Stratford, and a member of the 
Ancient and Arabic Order of the Knights of the Mystic Shrine at 
London. Major Sale was also a member of St. George*s Church. 

When the war broke out the late Major Sale was one of the first 
to enlist for King and Country to go overseas, having been a member 
of the 33rd Huron Regiment and Captain of the Brussels Company. 
The news of his death, by cable from the front, cast a gloom over 
the whole community. He leaves to mourn his loss, besides a host of 
friends, a widow (formerly Miss Kate Hughes Campaigne, of God- 
erich), a son of seven and a daughter of four years, also Ira, a 
brother, a South African war veteran, now in training for overseas 
service at Brandon, Man., and two sisters, Mrs. Albert Johnston, of 
Sarnia, and Mrs. Gilbert Porte, of London. 

The late Major Sale was elected a member of the Board of 
Directors of the Royal College of Dental Surgeons at the last 




(' \\ \\i \ \- ^ r i> w \ K- '^ *^ ^ 



biennial election, and was honored. res|>ccted and lo\ed by ho denial 
friends throughout thr whole Province of (^lario In h» loyal i*C* 
rifu (* fir has hrou^ht lasting honor to hi* chosen |*folcmon« 



Dr. j. W Maisl). ill, Ueceas^d, Toronto. 

DK 1 1' MAIOHALl. passed away, in h» <i6lh vraf tkUtr 
.1 prolraitrd illnew extending ovrr twe!%r m 11k lair 

l^r. Marshall practised dentistry foe o\rf 1%*' 4n m iW 

t(nvn of Shelh(niri)r. mo\ing t- T »'- J-".i |^ --^r-i 

whrre he coMlinued his pra« l!C« 

profession is extended to Mrs Mar>hall m hct brfra%mirnt 



ai r B 

' THE COMPENDIUM ' 

This Deparlnient is Edited by 
THOMAS COWLING. D.D.S., Toronto 

A SYNOPSIS OF CURRENT LITERATURE RELATING 
TO THE SCIENCE AND PRACTICE OF DENTISTRY 



Dental Physiology. 

ONCE out of school, the dentist is not very much interested- with 
Hterature concerning the physiology of the tooth. It is with 
renewed interest, therefore, that we read the views of Dr. 
Ragnar Eckermann, of Sweden, as contained in an article pub- 
lished in the Dental Record (November). Many of his statements 
will appear to be somewhat revolutionary in character, yet are of 
more than passing interest to dentists. Among the author's con- 
clusions these may be mentioned: '*The earlier a tooth erupts the 
greater is the volumetric proportion between weak and hard tissue, 
between pulp and dentine. The pulp chamber has then its maximum 
size; the walls of dentine their minimum size and the protecting 
membrane still has porosities. A tooth erupted at normal time has 
certainly also porosities on the enamel, but they are narrower, less 
numerous, and lie farther from the pulp, and would, of course, be 
subject to shorter exposure to possibly existing harmful agents than 
in the case of a too early erupted tooth. Late erupted teeth are 
embryologically more developed, and, consequently, have still fewer 
pososities, if any, in the protecting membrane, and are thus to be 
regarded nearly as immune from caries." 

On the assumption that a tooth is built up from the centre. Dr. 
Eckermann concludes that a too early erupted tooth has a more 
porous enamel than a normally erupted one, and that the tooth 
becomes more readily a prey to caries than would be the case of a 
normally erupted one. The more mechanical injury the enamel and 
dentine suffer (breaking hard biscuits, etc.), the stronger the tooth 
will become, because it hastens the retrogressive metamorphosis of 
the pulp, and the dentine changes into a tissue which can endure 
attacks. The factors favoring this process of the pulp are described 
as 

(a) Artificial (metal fillings, grinding of the cusps). 

(b) Natural (wear and tear of the teeth, hard mastication). 



ORAL H I : A I. I H 27 

Following this line of argumrnl. Dr Kckrrmann concludes thai 
owing to the relation between fillings and pulp-contraction it is bnt 
that young teeth be filled with metal, and that the grinding of the 
cusp5 of mature teeth may be indulged in as a |>rof)hylactx m^^ff * 
against canes. 

"I .verything which stimulates the retrogressive process is at thr 
same t-me a prophylactic against caries.** In an effort to subftantiat- 
this claim, the author points out **Iliat for purposes of good occlu- 
sion, when fitting crowns, we can grind off the top of the antagoni^l 
without a trace of caries being seen later on ^'e also daily wr 
people who have worn out their teeth until half of the cro\%'n or more 
has gone, the top of the tooth often forming a deep retention pUce. 
but nevertheless no caries has appeared.** 

Although not agreeing with the use of such radKal means lu 
bring about the deposition of secondary dentine, we. as dental |>rac 
titioners. know full well that such a process does go on to a grealrr 
or less extent if conditions be favorable. 

In ncntiil Cosmos (November). Dr. James K. (an rMjjrrii 

dental and oral surgeon in the l.piscopal Hospital. : i ' ' • 

reports an interesting case of the formation of secondary 
which came under his observation. He says: ** Ilie pat*ent. a I ' 
girl of thirteen years, presented with a carious up|>rr left first motai 
During process of excavation the pulp was accidentally exj>o*ed A 
dressing of Hlack's "I. 2. 3" preparation, with one-eighth grain ol 
cocaine, was applied as a sedative, and the patient told to return 
in two days. She did not return before the ninth day On of^ening 
th«" tooth, which had not given trouble in the inter naI. it was found 
that a depo.Mt of dentine had formed o\er the e.\jH>srd pulp Ilie 
new dentine was quite firm and of a lighter color than the surround 
ing structure." 

The views of Dr I ckermann are brought to the .\ ' 

readers of Okai. 1 IkaI.TM. not because of concur"-"- •- 
but rather owing \o their novel character It is ra: 
that he offers no explanation for the necessity of devit.\ of 

teeth that have bec( me sensitive through just such a |iroi 
ing) as the author claims will create a protecting In* — 
over the r<lro«ressi\e pulp Aga»n. why is -t that d- 
so often brought about bv such processes (mechan?cal \rv^ 
as. according to the author's theory, ought to cause immunly lo ihe 
pulp? 

Ki AsoN.s Tor Mi5Fittin(. Dkntirm 
In t^e November issue of l^-e /)c 'fit/ /<ctor«/. !> D M SKa*» 
(Loiu^m) summari/es some of the chef CAU«e» of faOure to r«l«o- 
duce the form of the 'mi^ression surface on th* 
I. Def(Mn\att>n of plaster cn«t surfv- '■• 
6> ) W'arpng by bad nrxna. • 

of water: or by hurried drvrng and o\erKeat ng 



28 ORAL HEALTH 

(b) Forming or trimming a thin and weak cast, or disturbing 

the cast during setting. 

(c) By expansion, when or after mounting on articulator, if a 

groove is cut in the base of the cast to let in the arm or 
bar of the articulator. 

(d) Bruising or rubbing of surface of cast, by careless and 

heavy handling. 

(e) Deformation or fracture when flasking, by leaving the last 

mould plaster to crystallize under the continuous pressure 
of the flask press. 

(f) Deformation of cast when packing rubber, by excess of 

rubber and undue pressure in closing flask. 
II. Deformation or warping of rubber after vulcanization: 

(a) Letting steam pressure down too quickly. (Time and 

temperature of vulcanizing is assumed to be correct). 

(b) A water-logged plastercast, or a cast from any cause too 

weak to resist contraction of the vulcanite. 

(c) Immersing the hot flask in cold water. Rapid cooling 

means unequal cooling — and therefore unequal contrac- 
tion of the vulcanite. 

(d) Opening the flask while the vulcanite in it is still too hot 

or warm. 

(e) Warping of vulcanite when softened by heat developed 

by friction in polishing. 

The X-Ray in Dentistry. 

Of late much has been written and spoken in support of the use 
of the X-Ray for dental purposes. There is at all times a tendency 
to label as "old-fashioned" those who advocate a policy of con- 
servatism when dealing with new and probably somewhat dangerous 
methods of practice. Fortunately for the dental, as well as other 
professions, a certain number of its members risk the imputations of 
senility and venture to erect a few danger signs, so plain that "he 
who runs may read." 

In an article appearing in November issue of Oral Hy^giene by 
Dr. J. Wright Beach, entitled "An X-Ray of the X-Ray," the 

author — one who has had extensive experience in X-ray work 

suggests that it may be made a "good booster for Ananias, and 
has one of the most accommodating characteristics of Holy Writ in 
that it mav be interpreted to suit the tastes and inclinations of the 
mterpreter." The question as to what extent rehance mav be 
placed in the radiograph as a means of diagnosis by the dentist is, 
in Dr. Beach's opinion, one of paramount importance. "It requires 
an unusual intimacv with its idiosyncrasies and great experience in 
its interpretations before a reliable opinion may be rendered." 
Unless the X-Ray apparatus is one of the improved and up-to-date 
outfits, the radiographs obtained may be very obscure and wholly 



OKA I, HKAL'I M 29 



unrrlialilr ii 



m cJiaKnosis **F.xi)«ricnce. common »ciue and good lodg- 
ment" outfit to be of supreme aid to the dentiit. and the X-Ray 
used only as a source of appeal. Dr FrederKk W. Frahm ukn 
u|) tins same point in the Dental Record (November). After itating 
that he has used llic Kornt^rn ray* since I^XM for ihew dtagnftftir 
value, he says: "I do not feel prepared to |x>sitively state iipoQ exam- 
ining a radiograph that a given condition prevailt. or thai certain 
pathological lesions are present Iliere is too much of an elemrnl 
of doubt surroundiriK such a dia^nosi*. and I would not f>e v%'ilhnf 
even to extract only one tooth on the simple findings of a radiogra(>h " 

Great emphasis has been placed in recent articles dealing v*ith 
the much-mooted question of root canal fillings. u|K>n the fact that 
radiographs show that a large percentage, as high as 97 per f-* 
of teeth whose roots are filled, have apical areas If this condition 
really obtains, then the dental profession must admit complete failure 
in one of its most important departments of operative procedure. 
Perhaps the case against the dentist is not as clearly proven as one 
would be led to believe. What \s the basis of the * % iodicl- 

ment? Clearly the X Kay findings are responsible . . ;..ese form 
sufficient material for diagnosis of infected areas > Not all persons 
whose opinions carry weight in the profe^ion hold to this view. As 
a proof of the error of placing too much reliance in the radiofr- 
it may be pointed out that from one film several f>rints may he m«ii«-. 
each varying in detail I he difliculties of de\ eloping, skill in pre- 
paring the fixing and clearing solutions, the evenness \%ith which thr 
tube works, the uniformity of gelatine these are all factors leacfaig 
up to the production of goo<l X-Kay prints. 

The use of the X Kay. as we have it to-day. ought, in thr tMimioQ 
of many, to be restricted. Its indiscriminate and unvieni may 

lead to grave harm to both the subject and o|>erAlor It may cause 
serious growths to form on the operator's h«tnd«. oc it may l>e the 
means of permanent injury from burns, to the X Kav sub|ect It i* 
even said to imp.iir the progemti\e |>owers of the male 

It might possibly be inferred from the foregoing that the X Kay 
has little, if any. place in the field of dentistry I hi« wcw \% A\.%Kxxrt\{\ 
not a correct one As Dr He.ich |M>int* out "P • «" ^'f fAdH> 

praphy is one of the greatest l)oons to drnli*tr\ e lurnlirfh 

century has yet produced, and it \%'ould be prr to say thai 

it has thus far appr<Mched its fullest de\e|oj>meni It mi«Kl br 

deemed advisable, in \iew of the .1 of it* un«rientifK u»r. to 

refer our patients to institution^ r.|.. ,..; with the br»! .«:<: arjiTm 
obt.imable and ha\e them comr mulrr the care of ^1 

in handling all the de\ices designed to secure the safety o| the X 
subject If such centres were establi»hrtl then a \rr cowUl ix 
arranged. Mifficientiv low to bring the brnrhl of •»- V »• - -'«»»n 
the reach of all. and at the same time rrthi* r l.> .\ a 

of injury to the subject Quoting Dr Beach araio 'It (tbe 



30 ORALHEALTH 

X-Ray) is an expensive plaything and a cheap necessity. When 
we need it, we need it badly, but when circumstances are the reverse 
we have no right to burden our patients with the uncalled-for 
expense." 

Diseased Tissues of the Oral Cavity. 

The discussion of this subject is usually left to the members of the 
medical profession. It is then with more than usual interest that we 
read Dr. W. C. Smith's (St. Louis) paper, which was presented to 
the Illinois State Dental Society in May, 1915, and reported in the 
November issue of the Dental Review. The author is quite frank 
in stating that he was led to a more careful consideration of the dis- 
eased condition of the oral cavity because of a sense of embarrass- 
ment occasioned through inability "to diagnose or suggest the etiology 
and treatment of a number of these diseases when consulted by 
physicians." Thinking that probably other dentists may have been 
in some such a predicament Dr. Smith essays to render assistance. 
He finds that dentistry is apt to become too specialized a branch of 
medical science. We ought not to confine ourselves exclusively to 
treatment of tooth lesions. Would it not be advisable then for our 
colleges to extend somewhat their curriculum of studies so as to 
include the diagnosis and treatment of the most common diseases of 
mouth tissues? It may be said by some in opposition to such a 
departure that this work is not properly the dentist's, and that in 
attempting treatment of such diseases we are usurping the function 
of the physician. With this view many may, in part at least, agree, 
yet no one will venture to dispute the vantage ground of the dentist 
in being, in a great many cases, the party to v/hom is afforded the 
first opportunity of seeing indications in the mouth. Is it not true 
that most persons seek the advice of a physician only after the affec- 
tion has well advanced? If the dentist does not deem it within his 
province to treat disease of the mouth tissues, he ought surely to be 
able to accurately diagnose such conditions and refer the patient to 
the physician for early attention. In this way, perhaps better than 
any other, can we hope to bring about the desired co-operation 
between the dentist and the physician. 

The Tongue. 

Dr. Smith finds in the appearance and superficial condition of 
the tongue an index to most gastric and to many other general dis- 
turbances. Tremulous action, extreme dryness, blueness, a very red 
shinmg glazed aspect — all these are indications upon the tongue of 
dangerous conditions. 

Ludwig's Angina. 

Septic infections of the floor of the mouth and the neck are usually 
secondary to some infection in the mouth, nose or pharynx. Broken 
down teeth may be the means by which the infection enters. In the 
infection of the cellular tissue planes there is the condition of cellu- 



ORAIH l.AL I H 31 

litis. If this infection becomes rapid and extensive, a ''^mdWiwi 
obtains known as "Ludwig's Angina." Iliii u an acute •prcadnf 
infiltration of the soft tissues, starting in the floor of the mouth and 
sub maxillary region, which binds all the strurlurr^ into a hard. 
board like mass. 1 \m mass becomes attached to thr jaw Ijooe and 
presses the tongue upward and backward into the pharynx I*neu- 
monia is often a complication. As a means of treatment free inctsioci% 
are resorted to. wounds arc packed with gau/r and are never sutured 
1 he author would have dentists become proficient in the early 
diagnosis of this condition because of its high rate of mortahtv. 
Delay adds greatly to the difficulties of treatment 

Syphilis. 

I his is a disease whose baneful results place it at the head of the 
list of all diseases of the human body. It is one of the dtseases that 
is on the increase a fact th<it causes us all to (>aus« and consider 
means for its eradication. W hatever excuse may be olfoed for 
ignorance in detecting other diseases peculiar to the soft tiituct ci 
the oral cavity, surely none can be offered for the dentist's lack ol 
skill in the diagnosis of syphilis! I o proclaim a dental o|>erator. vrHo 
is careles.s or indifferent m this {particular, a criminal is not too severe 
an indictment. Some of the greatest manifestations of sy|>hiltft are 
in the oral cavity, and many of them are highly infectious. Here, 
then, is a source of danger not only to patients, but also to the denim 
h mself ' I is true that there are certain stages in which sy|>hilitK 
discharge may be non-mfective. yet there is need of extreme caution 
at all limes. Skill in diagnosis is of paramount im|>oftance Students 
in our dental colleges ought to receive full instructions in this regard 

Dr. Smith says "The minutest amount of discharge from ^ 
syphilitic sere in certain stages of the disease will ine\it4'ibly (produce 
the chancre, which is the initial lesion " W'heie a <lrn?*' » ^liiiivr 
that the mouth ulcers are syphilitic, then the nu^t com); rw ol 

sterilization of instruments should be resorted to. It i» ilrrmed »a\n 
able to destroy such things as napkins, rubber dam. etc . rather than 
tru't to the efficiency of any method of slenli/alion 

"The oral lesions that are dangerou*. aside from the primary 
chancre, which may appear upon the lip* or in the mo^ith. I>rlnfif |o 
the secondary, the eruptive stage, and consist of the i\r m 

mucous membr.tne. and are analagous to ihow lak 
skin. Syphilis m.w. or may lu^t. pass throii . ' 
and secondary. It is only when ac(|uire<l ! 
firesenls all its characteristic phenomena W hen il » €• 
without the initial lesion the chancre " \^^r chancfe n ** 

p(Mnt of infection, but does not make it* Ap|warAme until ^ ^ 

ten to sixtv davs have pas^srd llie ch^' --^ -*»»ch it > 
iiKlication of syphilitic |Hiisomng. present* i; ^UMMni; 

First, an incubation perux^ which is al>out twenlv one 6mf% >■ 



32 ORAL HEALTH 

certain special charactertistic appearances. Some kind of a papilla 
or pimple situated at the point of infection and varying in size. It 
is dark in color, elevated a little above the general surface, and is 
embedded in an indurated sub-cutaneous, infiltrated mass which, 
between the thumb and finger, feels like cartilage. After about ten 
days the epithelia upon the surface of the chancre softens and it 
becomes covered with a grey film. The central point ulcerates and 
discharges a serum which is highly infectious. Third, soon after the 
appearance of the chancre, the nearest lymphatic gland becomes 
enlarged and undurated, thus indicating the beginning of the con- 
stitutional affection. In the mouth and in the mucous membrane the 
eruption is usually first seen in the macular form — that is, reddish 
or copper-colored spots. Dr. Cameron (Cosmos) says that many 
cases of syphilis have been reported to the Episcopal Hospital, Phila- 
delphia, all evidence pointing to the dentist as the disseminator. He 
also refers to nine cases of syphilis reported by Baldwin of Chicago, 
all being contracted during dental operations. Two dentists were 
infected as a result of operating upon diseased patients. 

Dr. Smith concludes his valuable paper by urging all dentists to 
form the habit of examining carefully all lesions of the soft tissue of 
the mouth before beginning to operate on the tooth tissue. 

Germicidal Properties of Dental Cements. 

The great need of research work to ascertain which are the best 
materials to use when making restorations in the mouth is at last being 
recognized. In quite a number of the universities of the United 
States experiments are being conducted with a view to rendering 
dental operations more permanent in character. 

As illustrating the benefits of such research work let us consider 
the finding of Dr. M. R. Smirnow, as a result of experiments carried 
on in the laboratories of Bacteriology and Pathology at Yale Uni- 
versity. The question of the germicidal properties of dental cements 
received his attention. The following cements were used in the 
experiments: (1) "A pioneer and admittedly reliable black copper 
oxid cement, which boasts of a very high percentage of black copper 
oxide and extraordinary germicidal qualities; (2) A red copper oxid 
cement, which claims to be the first of this particular form of cement, 
advertising a content of 25 per cent, red copper oxide; (3) One 
white copper cement; (4) A light greenish-yellow copper cement; 
(5) An ordinary zinc oxide or oxyphosphate cement." 

Various methods were devised in order to make conditions of the 
experiments similar to those to which the cements are subjected when 
used in the mouth. For instance, one line of tests dealt with the 
action of cement pellets when placed in cavities of extracted teeth. 
The results were carefully tabulated, and the findings ought to prove 
of great interest to all practitioners. One of the conclusions arrived 
at was that very efficient antiseptic qualities of the cement are due 



OK A I, Hr.AI. 1 H 33 

l?artly to the action of the phosphoric acid contents ol the bquad 
It was also found that a cement, used at a filhnK matrrial. may act 
gcrmicidally in several way?: First. "By mechanical meant, in ^llinf 
up the cavity and depriving many of the organisms |>re4mt frocn the 
free oxygen they re(|uire for their sustenance ,<^ . i i\^ ccmcot 
pellet forms a very effective barrier to all form^ • (ion. lO that 

many of the bacteria may succumb on account of lack of nutriment 
I hird. the pellet may aUo act as a barrier to the prof>eT ditpONlioa 
of the waste products of bacterial growth which, if a< ' ^ ' lU 

act as an inhibitory agent to the farther proliferation : ..a. 

Fourth, the actual antiseptic or germicidal action of the crmctit 
itself." 

I aking up the last item, namely, the actual anti^rpiic or grnni* 
cidal action of the cement itself: It was found that there are gradn 
of germicidal efficiency in the cements tested. Ilie two moft HBcienl 
cements were the black and red copper cements, and of iKese two 
the red copper cement easily surpassed the black coj>|>er ccncfil in 
germicidal pro|)erties. I hese cements of a lighter color, e^en ihoie 
having copper contents, were far inferior to the red and black coppcf 
cements. "Under these tests, red copjjer oxid cement excelled all 
others, showing evidence of but three failures in twenty-five teeth 
tested." 

SfXONDAKV \ ii MUKKHAGK. 

Occasionally a case of hemorrhage is presented wIikH cause* con* 
siderable trouble in treatment. Fortunately, few cases prove as 
persistent as the om* rei>orted by Dr. James R. Cameron. Cotmos 
(November issue), which is here cited because of the method ol 
treatment adopted. A man lifty-five years of age had a secondary 
hemorrh.ige fise days after the teeth hati been extracted, under a 
local anesthetic llie sockets were first packed with tannic acid and 
glycerine on cotton. No relief resulted Ilien each »ocke« was 
packed with plasttr of I^aris. but the bleeding continued A •rrond 
packing of piaster of Pans followed and a wad wa» placed in ihr 
mouth, the jaws tightly closed and a Barton bandage a|)filied. 
Hemorrhage persisted Patient was then gi\en t^*o fucce«si%e nd- 
ministrations of horse serum (15 CC ) A shuht im|irovefnent was 
noted This was only leminnary. however, foe blood commenced 
oo/ing again The plaster of Pant was removed from the vockcfs 
.uul H) per cent. Argyrol was inserted on a cotton y^^d l"hi« 
arrested the bleeding. 

FUTURK Oh Dt.NTI5TK> 

Of dentistry one may say. the |>ast i» gUxious; its future -d 

with opportunities .A retr«>^pect of dental * ' * ** 

record of successful sti ' - foi "n place in " ii. i .^J' i 

to give us a certain i »ble coiueit A <- at the future, 

however, sobers our thoughts with an almost cruthtnc effect* A* 



34 ORAL HEALTH 

suredly, the opportunities for service are great; yet opportunity begets 
responsibility. Shall we respond to popular demands? 

Our colleges enjoy special privileges bestowed upon them by the 
State, and are in a sense autocratic institutions by virtue of the fact 
that they, and they alone, can arrange courses of study which, when 
completed, will render the graduate qualified to practise. The ques- 
tion which ought always to confront the governing bodies of such 
institutions is that of the sufficiency of the curriculum of studies. There 
must be progression or retrogression. No intermediate status is 
possible. 

Dr. William Hopkinson (Milwaukee), in his presidential address 
before the Wisconsin State Dental Society, Dental Review, (Novem- 
ber), says: "Mechanical dentistry must, and always will, be a 
major part of our dental education, but many of us have been com- 
pelled within the past year to realize the serious relationship of 
medical dentistry to the general health of our patients. We realize 
that the demands of the times is for a higher standard, that study 
and research have developed the general inter-dependence of all 
bodily tissues and their functions, that dentistry is a special depart- 
ment of medical science and embraces the structure, function and 
therapeutics of the mouth and its organs, together with their surgical 
and prosthetic treatment. The time has passed when he who 
assumes the care of the mouth, and thus guards and protects the 
main portal of the entire organism, can feel that his work is accom- 
plished by filling cavities and inserting teeth." 

This expression of opinion by Dr. Hopkinson clearly implies that 
without letting go of the mechanics of dentistry we should teach 
more of the medical science, or in other words, dentists ought to be 
"taught medicine in so far as it is applicable to the specialty of 
dentistry.'* 

Dr. Weston A. Price (Cleveland) also sees a broader sphere of 
activity opening up for the dentist. In his address before the Illinois 
State Dental Society, May, 1915, he says: "Chronic disorders are 
largely the result of a focus of infection which may themselves be 
very slight, but there is a definite focus of infection in some part of 
the body, and of all districts of the body where a focus of infection 
is likely to occur, the mouth seems to be universally the most common 
and the most frequent. Where does that put the dental profession.*' 

Some of the most vexing problems for dentists involve in their 
solution a special knowledge of pathology and bacteriology. Where 
shall we find the men to do research work? Can we reasonably 
expect a student taking a general course in dentistry to acquire this 
special information? Hardly! Are we to expect new graduates to 
immediately take up these problems of dentistry? Again we answer 
in the negative, because under the conditions which obtain to-day a 
student upon graduation most likely is in debt owing to the expense 
of his tuition to which burden must be added an additional one, the 



OF<AL URALTH 3S 

cost of his office cquipmrnts. \{\s imnirduilr ti 4 

financial one. Wt- turn then lo our third and lav: ..k .. -^.^c ihc 
established practitioner. A successful practice invoKe* loQf and 
diligent work I he dentist seeks rest during his evening hours. Can 
we im|)ose upon him laborir)us research work) f^ossibly a few 
enthusiasts do not object to beginning work anew in thr rvming, but 
most do Clearly the wisest plan is to induce men who havr «pccial 
talents along particular lines and who have had chnKal ex|>eneiicr 
as well, to devote the major part of their lime lo some branch oi 
dental research work, for which there must he provided adequate 
compensation. I hat such a plan will be producti\e of good resulU 
is evidenced by the work of the various research departments now 
being concKicled in connection with several of the leading univertilies 
of the L nited States, repoits of whose work reach us almost daily. 

I here seems to be great need of co-operation between those hav- 
ing experience as practising dentists with full knowledge of condi- 
tions of the mouth, and those having laborator>' ex|>enence NX'heo 
such a relationsliip obtains there is less likelihood of a laboratory 
researcher going out of his way to force views ui>on the prolcmon 
which at the outset seem to be. and in practice usuallv prove to be. 
ridiculous. 

Dr. M. L. Rhein (New ^ork), m a discussion of ihis subject. 
Cosmos (Novemlx-r), says: "It is unfortunate to h«\e a good 
laboratory investigator try to use his laboratory techncjue in a field 
with which, clinically, he is ignorant. It is on this very »%ccotinl thai 
a great many of our best laboratories have refused lo lake up the 
investigations of dental subjects Iliey have frequently said to me: 
"If you wish lo obtain practitioners of dentistry trained lo do labora* 
tory work to go into our laboratory, we are |K*rfeclly willing to work 
out the topic. There is no one in our laboratory who underslan<l» 
ihr rn( ulh properly, and conse(|uently one who is fit lo handle the 
sul)ject." Many objectors to this Mew of the silualion will sav thai 
it is not the purpose of a college to develop s|>efMli«ls. but rather to 
graduate g(M)d practitioners. lliere is good reason in thi» view, yti 
can we say that our colleges are doing even this well) One of ih^ 
strongest indictments of the dental profession cooies fr 
III the November issue of f^cntitl Cosmn\ ap|>ear« an .\ 
j.imes K Cameron, residrnt dental nirgeon. |-.pi»coj 
Philadelphia Me sayt; "llie lack of palho|t>gKal know*rdgr ami 
of ihr practise of asepsis in many denial | ^''^ 

of the best known surgeon* of the ct\ .»t i ni.^ur j m.i .« .i»an ol 
international reputation, in speaking before the clinKal »ociH\ <>l ihi* 
hospital, said: "Hie dentists as a class know v«¥ lutle aUxif ^rirfe 
infections of the oral cavity, and less alnHii *.** Again Dt 

Cameron says: "What a broad field . -» rvrry day 

practitioner of denliMrv to combn' • • - i%an wlio 

cannot make a reas«Miablv correct »i - f a mA . hMmsi 



36 ORAL HEALTH 

in the oral cavity or associate parts is indeed a very poor representa- 
tion of modern dental surgery." These statements are not new, but 
rather old ones emphasized perhaps a little strongly; but then it is 
just a judgment of ourselves by one of ourselves! In support of the 
claim that many dentists know little about sepsis, Dr. Cameron says: 
"Many practitioners of dentistry boast that they never sterilize their 
instruments. It would be of interest to know just how many people 
have been inoculated with syphilis by this class of practitioners. 
Cases, suffering from syphilis, have been reported to this and other 
hospitals, all evidences pointing towards the dentist as the dissemi- 
nator. Baldwin, of Chicago, reports nine cases of syphilis contracted 
during dental operations, in two of which dentists themselves became 
infected through carelessness." 

Whatever may be the difficulty in training our students to become 
expert in bacteriology, etc., there should be no half-measures adopted 
in making sure that our graduates know enough about asepsis and 
are sufficiently intelligent to practise them. But to return to the 
question as to the status of dentistry during the next decade. The 
future of dentistry lies apparently with those men who have a know- 
ledge of the mouth conditions as a dentist finds them; who are 
skilled in laboratory technique, and have a sufficiently broad educa- 
tion to draw the correct conclusion from scientific experimentation, or 
to quote Dr. M. L. Rhein, "Clinical knowledge is just as important 
as is laboratory research work; the two factors must be combined by 
men of the proper mental acumen to be able to understand both 
factors." Are our dental colleges prepared to develop just such men, 
or will the coming generation have to apply fresh paint to that old 
sign, "Situation Vacant"? 



Extensive Manufacturers' Exhibit. 



AN announcement of interest to the dental profession has been 
made concerning an elaborate exhibit of dental office equip- 
ment, furniture, materials and instruments, at the Hotel Audi- 
torium, Chicago, on April 4th, 5th, 6th and 7th, 1916. 

While this meeting is primarily a manufacturers' exhibit, prepara- 
tions are under way for a special development of the scientific side 
of the meeting, with numerous table clinics and demonstrations under 
the direction of the men who conduct the Manufacturers' Labora- 
tories, assisted by expert demonstrators and lecturers. 

The meeting will no doubt offer much of educational value to the 
practising dentist, and the sessions should be taken advantage of by 
members of the profession who can arrange to attend. 



Maritime Denial News. 



Rkportrd by Grorge K. Thompson. DDS. Halifax 



Dl< KAIJMI II WCXJDBLK^' has been appointed Go% 
• rnmrnl rcfirescntative to the School Board of the City ol 

Halifax. 

In the School Hoard c5tim<itrs .ipixars $1,000 for dcniuXxy and 
eye trralnicrjl. 

I \\v Halifax Dental Society has rrcommcndcd the appovnlment 
of a Dental Inspector for the Schools of the City of Halifax 

Lieut. Karl I. Woodbury, C.A.D.C. has been detailed to No 7 
Stationary Hospital, the L'niversity of Dalhous:e unit authon/ed by 
the VI ar ( )ffice. and which will probably sail al>ouI January I. 

Lieut. Woodbury is the youngest son of Dr. Frank Wood* 
Provincial Representative on D.D.C., and graduated from the Den- 
tal DeparlnnTil of ihr L^niversity of Dalhousie last spring 

I he organization of the Home Sersice branch of the C.A. D C. 
for the 6th Division is proceeding satisfactorily Ca|>t. Geo K 
I homson is officer in charge. 

Hon. Captain Jas. M. Magee and Otto Nase have received 
appointments as Captain and Lieutenant respectively. 

Foronto Rillc Club. 

A\l.l<^ intcK'sting meeting of the Toronto Kiflr r't"^ wa* 
leceiitly held at lh<- Dental College, when a COO*: wa* 

adopted and the question of drill and rifle |>ract)ce thofoughl> 
discussed. 

( )fficers were ch'cled as follows: 
C aptain Arnold Semple 
Secretary Geo. P. Phillips 
I reasurer Sydney W Wwillett 
l-.xecutive \V I! K»i<l I I Kruger. R, A. Peaket. Cjeo, U. 

Jord.iii 
Auditors I .\ Currie. A J Broughlon 



T 



T 



National AMOciation of Denial Facuh:e$. 

II*. National Association of Dental Facullie* will Sold il» nril 
meeting at the Srelbach Hotel. Loips\ille. K\ . Julv 22nd and 
J4ih. I Old. Charles C banning Allen, Sec. 



National Dental Awociahont. 

II . National Dental .Association will hold A» lw«HK«h ar""«» 
session at Louisville, kv . bi'^ 2'». 26. 27 and 26. 
Headquarters will be the > h Hotel 




CANADIAN ARMY DENTAL CORPS 
Overseas* 



army 



lose 
address is 
known. 



Lt.-Col. J. A. Aimstrons". 
Major O. K. Gibson. 
Major A. A. Smith. 
Capt. J. W. Bell. 
Capt. C. Brown. 
Capt. J. F. Blair. 
Capt. G. N. Briggs. 
Capt. W. J. Bentley. 
Capt. G. S. Cameron. 
Capt. O. A. Elliott. 
Capt. E. A. Grant. 
Capt. W. R. Greene. 
Capt. George Gow. 
Capt. O. G. Hassard. 
Capt. J. E. Holmes. 
Capt. G. G. Hume. 
Capt. F. W. B. Kelly. 
Capt. H. LionaLs. 
Capt. F. R. Mallorv. 
Capt. V. C. :\Iulvev. 
Capt. A. E. Mullin. 
Capt. B. L. Neilev. 
Capt. G. H. A. Stevenson. 
Capt. L. N. Trudeau. 

tMajor W. R. Clayton. 



Capt. T. C. Bruce. 
Capt. S. H. Simpson. 
Lieut. J. T. Adams. 
Lieut. S. G. Alderson. 
Lieut. N. S. Bailey. 
Lieut. D. J. Bagshaw. 
Lieut. F. C. Briggs. 
Lieut. T. W. Caldwell. 



Capt. A. W. Winnett. 
Capt. C. F. Walt. 
Capt. J. E. Wrig-ht. 
Lieut. H. F. Alford. 
Lieut. G. Atkinson. 
Lieut. R. H. Atkey. 
Lieut. W. A. Burns. 
Lieut. C. H. Brav. 
Lieut. G. W. Bray. 
Lieut. H. Clarke. 
Lieut. A. R. Currie. 
Lieut. G. H. Fowler 
Lieut. A. A. Garfat. 
Lieut. W. H. Gilroy. 
Lieut. D. H. Hammell. 
Lieut. J. W. Hagey. 
Lieut. E. W. Honsinger. 
Lieut. E. C. Hutchison. 
Lieut. R. Jamieson. 
Lieut. J. L. Kappele. 
Lieut. E. J. Kelly. 
Lieut. O. Leslie. 
Lieut. A. G. Lough. 
Lieut. W. G. MacNevin. 
Lieut. C. E. McLaughlin. 



Concentration Camps 

Lieut. C. E. Campbell. 

Lieut. A. V. Cashman. 

Lieut. R. L. Dudley. 

Lieut. J. Duff. 

Lieut. W. R. Eaman. 

Lieut. R. W. Fell. 

Lieut. J. P. Gallagher. 

Lieut. G. E. Gilfillan. 



Lieut. R. McMeekin. 

Lieut. B. P. McNally. 

Lieut. E. McNeill. 

Lieut. H. C. Macdonald. 

Lieut. E. D. Madden. 

Lieut. V. C. W. Marshall. 

Lieut. L. L. Matchett. 

Lieut. G. V. Morton. 

Lieut. J. F. Morrison. 

Lieut. J. B. Morison. 

Lieut. C. H. Moore. 

Lieut. P. E. Picotte. 

Lieut. H. Ross. 

Lieut. J. Roy. 

Lieut. W. A. Sang-ster. 

Lieut. J. F. Shute. 

Lieut. D. P. Stratton. 

Lieut. R. C. H. Staples. 

Lieut. E. S. Tait. 

Lieut. A. E. Thornton. 

Lieut. H. P. Thompson. 

Lieut. H. P. Travers. 

Lieut. D. D. Wilson. 
Sg-t. Jas. G. Roberts. 
Sg-t. J. W. Macdonald. 



Lieut. J. S. Girvin. 
Lieut. G.H.Hollingshead. 
Lieut. H. C. Jeffrey. 
Lieut. C. M. Joyce. 
Lieut. W. J. McEwen. 
Lieut. J. A. Stewart. 
Lieut. V. D. Wescott. 
Lieut. G. A. Wilcox. 



Capt. A. Dubord. 
Capt. H. T. Minogue. 
Capt. F. P. Shaw. 



Divisional Officers 

Capt. W. G. Trelford. 
Capt. Geo. K. Thomson. 
Capt. W. G. Thompson. 



Capt. F. M. Wells. 
Capt. J. M. Wilson. 
Capt. ^^r. W. Wright. 



tActing Chief Dental Surgeon, address, Ottawa. 

♦Lieutenants rank as Captains while overseas. 

C.A.D.C. overseas address— Care Chief Dental Surgeon, Canadian Ex- 
peditionary Force, Folkestone, Eng. 



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M'.WT l.j^r? 



ATTACHED TO CORPS OTHER THAN C A O.C. 



Mftjor r. r. IM. 
Major F. T 
Capl. K. C. • 
('apt. ('ha-*. \ 
Capl. K. n. S 
Capt. J. I. M 
Lieut. A. It. I 



Overseas 

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Concentration Cam( « 

l.»i-Ut.-«'-l. •'■ 1 I" I' \ ■ 

Major i 
Major 

('apt. A. U J. 
Lieut. C. K NN 
l»rlvale I). W M '-••>. \y*\\\ niti 



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UNDERGRADUATES 
Overseas 



I; H \tkoy 

P. H. Harry. C.A.O.r. 

\ I M.I ri. »..•.« « • \ I I t« 

I .It! 

I . 

J. K. li v\ III. i*..V.l»,«' 

A. \V .Imm..- «• \ IMV 
J. V. L. 

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Or;tl Health will apprvcial* rvcviving f\3kn*9% »'• 
tion thAt will makt thvt* pao«« a r-^- *"•' 
•t;«ntly Avail «bl« to vv«ry 



<♦* 



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MULTUM IN PABVO 

This Department is Edited by 
C. A. KENNEDY, D.D.S., 2 College Street, Toronto 



HKlPKlil PRACTICAL SUGGESTIONS FOR PUBLICATION, SENT IN BY MEM- 
"KR^0^rHF?H0KEss,0N WILL BE APPRECIATED BY THIS DEPARTMENT 




D 



Method of Improving Polishing Strips. — If both sides of 
polishing strips are drawn over a piece of paraffin wax before using 
they will work better and more rapidly, and will not be spoiled by 
moisture. This improvement is most marked in strips of coarse gram. 
— La Odontologia Colombiana. 

Cavity Toilet Preparatory to the Insertion of Synthetic 
Porcelain. — The toilet of a cavity preparatory to the insertion of a 
synthetic porcelain filling must be as thorough as if a metal fillmg 
were to be used. To the ordinary toilet should be added the var- 
nishing of the dentinal walls as a precaution against the material 
absorbing either acid or moisture from the walls or against the absorp- 
tion of part of the fluid from the material by excessively desicated 
dentine. Usually the rubber dam should be applied. — C. Davis, 
Western Dental Journal 

Taking Impressions in Persons Who Have Worn Den- 
tures Before. — It has been observed that, after a person has worn 
a denture (especially one of vulcanite) for some time, the mucous 
membrane swells slightly. This is the reason why new dentures often 
do not fit satisfactorily in such cases. As the mucous membrane 
returns to normal condition within about twenty-four hours, if no 
plate is worn, the patient should be requested to go without a denture 
for that length of time before a new impression is taken. — La Odonto- 
logia Colombiana. 

Deaths From Anaesthetics. — The annual statistics of births 
marriages and deaths, as published by the general registrar of Lon- 
don, present the following interesting data: During 1914, 296 
casualties were connected with or directly due to anaesthetics, thir- 
teen cases more than in the previous year. In 1 1 1 cases the anaesthe- 
tic is not specified. Of the remainder, 1 1 deaths were due to chloro- 
form, 25 to chloroform and ether; seven to alcohol-chloroform-ether 
sequence; seven to nitrous oxid; five to ethyl chlorid; two to hedorial; 
two to cocain; two to alcohol and chloroform; one to stovain. — La 
Odontologia. 



ir 



1=1 r 






ORAL IlKAITIi 



EDITOR 
WALLACE SECCOMBE. O.O.S.. Toronto. Ont. 

CONTRIBUTING EDITORS 
GEORGE K. THOMSON. D D S . H.»i.f«H, H.%, 
F. W. BARBOUR. DOS. Frrdrncton. H.%. 
ASHLEY W. LINDSAY. DOS, CheoQlu tio Clltt««l 
J. WRIGHT BEACH. DOS.. Buffalo. N.V. 
T. W. WIDDOWSON. L.D.S.. London. CnglAncf 
J. E. BLACK. D.D.S.. Vancouver. B.C. 
MANLY BOWLES. D.D.S.. Winnipeg. Man. 
J. A. C. HOGGAN. D.D.S.. Richmond. Va. 
EDGAR O. COOLIDGE. O.D.S.. Chicago. III. 

RICHARD G. Mclaughlin, d.d.s.. Toronto. 



jM-riptlon I'rl«-»*: 



$1 oo; (>tli.T « 



OrlKlnnI romrnunicfitinnn. liook li- . .• a i > 
I'<*rj«onal ItAimii and other t'orrcapomi' in t. „:..^...: „. 
Hdltor, Oral H<>alth. 269 Co|les« St.. Toronto. Canada. 

Submrlptlonjt nnd nil bUHlnrnn . 
to Th«« rul»llsh«rM. Oriil H«alth. 2» 



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addr«ajw4 



\ol. \ I. 



n n{( >NH y I \M \m , p*i(. 



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Dental Research in Canada 



Tl II I^F. is no more important work hrforr \\\c cirntal profrMKiii 
<»f Canada than llir or^tini/ation aiul tlirrclion * T^-...,| 
l\«March. I lu- N.itional Denial /VvvKialion of ' ! 

States has. through its Krrcarch Commission. accomph«hrd magi 
ficcnt work ciuriHK the past two years I hr attainmrnl* of lKi« Iwcn 
arr at oner a boon and an inspiration to Dentistry thrtxiglxxit ihr 
world 

I low t «in the driital profession of ihi* [dominion l>esl iniliale an*! 
direct Dental Krsearch? Canadian dentists ha\r di«<-u«srd iIk* 
prohirm upon many occasions, and there seem* lo be i 

j>osili«)H l«> look to ihr I^rntal College for le.A ' * 

matin Dalhousir. 1 .a\al. McCiill. and the i 

Surgeons, working under some co-o|>erati\e plan lo |ife\enl ? 

duplication, could accomplish much in Dental Ke*rarth with a mm 

mum of expense I he ct»llege^ nrrtj not In- ■ 

whole burden of the wotk. hut n>uld call l*» 

(Hca5U)n nughl demand, members «»f the dental o« 

who have the ability and inclmal'on lo help A I' 

tage would accrue to dentistry through the mfiuence ol >i«dt a »"'^ 



42 ORAL HEALTH 

ment upon the younger members of the profession and upon the under- 
graduate body generally. Many students pass through our dental 
colleges to-day without having either acquired the "reading habit" 
or received an inspiration to work toward the solution of the many 
unsolved problems of the profession. 

As evidence of what may be accomplished for Dental Research 
through the agency of the Dental College, the work of Dr. Harold 
K. Box, of Toronto, is of interest. Dr. Box was appointed R.C.D.S. 
Fellow at the time of his graduation in the spring of 1914, and was 
engaged for whole-time all-year service, working under the direction 
of Dr. Joseph Graham, Department of Pathology. During the year, 
extensive work was done, covering the histology and pathology of 
the dental pulp. Hundreds of microscopic sHdes were prepared, 
showing the progressive and retrogressive pathological changes that 
occur in the dental pulp. Dr. Box also found time during the year 
to make certain bacteriological studies, and, following Naguchi's 
technique, cultured pure fusiform bacilli. 

Upon reporting the work of the year to the Board of Directors 
at the annual meeting in the spring of 1915, Dr. Box was invited to 
continue his research and was appointed for half-time all-year ser- 
vice during the past year. This action of the Board has been 
abundantly justified. The work of Dr. Box during the past year 
has embraced studies on the peridental membrane, normal dentine 
and alveolar process. The innervation of dentine has long been a 
controversial subject among histological authorities and investigators. 
It has been held that sensation in dentine is due to the protoplasmic 
content of the dentinal tubule rather than to the presence of actual 
nerve processes extended from the pulp. Dr. Box, however, has 
recently completed microscopic work which would seem to prove 
conclusively the presence of actual nerve fibre in dentine. 

Dr. Box's work during the past two years is of such outstanding 
value to science and dentistry that it is to be hoped the Board of 
Directors of the Royal College of Dental Surgeons will publish in 
pamphlet form the report of Dr. Box's work and thus make it avail- 
able to the entire profession. 

Members of the dental profession in Canada are certainly more 
virile than to sit idly by while their American confreres unselfishly 
spend their money and sacrifice their time and energy in an effort 
to bring light and understanding to many things that are now 
dentally obscure. Otherwise, Canadian dentistry would play the 
ignoble part of a sponge, profiting by all that others bring without 
adding its own quota of helpful service. Just as Canada believes in 
"playing the game," so Canadian dentistry, with the blood of youth 
in its veins, will bear its own proper share of the research burden and 
make what sacrifices are necessary for the early establishment of an 
aggressive organized plan for Dental Research. 



Oral I l\'^i'[ir K'porls. 
Waterbury. Conn. 

Ww mailer of oral hygirnc. the carr of the mouth and trHh at a 
prrvenlivc of disrasc. is jusl now receiving s|>ecial attenlKXi from the 
Watcrbury Women's Club, winch is asking that an a|>|>ro{irialiaci ol 
$4,000 he included in the municipal budget for the pur|KMe ol pfo- 
vidin« for ihr first and second grade I'ublic School children adequate 
dental inspeclion and work. 

H\c report of the work so successfully done m Bndgefxirt it very 
enlightening. It shows the importance of a clean mouth, to that 
clean food, for which so much is being done by health author 
shall do lis proper work in the nourishment of the Ixxiy. and how tnc 
number of cases of disease among scho<j| children has been materially 
lessened by proper care of the teeth. Ilie tooth-brush drills are 
described, and ihe report is one which should be of real mterest to 
all who are responsible for the care of children 

\V aterbury has plenty of good dentists, who are thoco<ii'^»' 
formed concerning the latest developments of their branch of il 

science, and who will be able to plan satisfactorily for thorough 
inspection of the mouths of the younger school children and such 
dental work as may be found necessary. I liey will be ably asAisted 
in this work by the i\il)lic School teachers, and there i* no reAtOO 
why the good results obtained in Bridge|>ort and other cities should 
not be duplicated here. I^ridge|)ort began by appr«' ^ ■ O 

and has increased this appropriation to $I2.(K)() W ri 

a smaller school population, is asked f<>' '^4.000 to sta:t :.. 



CiNciNVATi Orai IhciLNE Work. 

Till. "Oral Hygiene Week" campaign of the Cincinnati Dental 
•Society closed at the University of Cincinnati mth a lectuie lo 
the Association of Collegiate .Alumnae by Dr. Haf\rv \\ 
\V il<>. of Washington. D.C . juire ftxxl ^"^ — t 

Di. Henry Cierman. President of {\\r ly. is refwrlrd to ha%r 

said: **'Ilie campaign was a huge succrw Fifty thousand ichool 
children were each proxided with a tooth-brush and laughl how to 
use It properly. 

"I he most important thing to be done now is to follow ur» the 
work, and that will de\ol\e upon the parents and t«*.i 

Dr. Wiley also spoke at a meeting of the C 
Gibson. He called the members of the ( ^ 

public benefactors I le said that when he 1 

to look at then chilclien's leelh m*lrad . : ^ 

facial beauty of the tots. 



44 ORAL HEALTH 

"That's the modern, beneficial spirit. The greeting of the future 
will be not 'Good morning, how are you to-day?' but 'Good morning, 
how are your teeth?' " 

Dr. Wiley told the clubmen that there were probably three or four 
dozen among them with mouths that needed instant attention, which 
were not causing their owners any serious inconvenience, but never- 
theless were a constant menace to the health. 



The Tooth Brush. 



IT may be true that the adoption of simple habits of living and the 
thorough mastication of properly selected food would ensure a 
condition of health for the gums and teeth of the human race. 
One would, of course, have to presuppose normal alignment, occlu- 
sion and contact. But how many such cases are found in practise? 
How many people in this busy age live the "simple Hfe," properly 
select their food, or thoroughly masticate it? Modern methods of 
living are far from nature. They are artificial, and artificial means 
must be employed to obviate the distressing results, one of which is 
the increased susceptibility to dental disease. 

Of all the artificial tooth cleansers, nothing has yet been devised 
for general use that equals the much-maligned tooth-brush. The 
tooth-brush certainly has many faults, but its efficiency is proven in 
the condition of the teeth of the people of Canada and United 
States as compared with countries where the tooth-brush and good 
dental care do not prevail to the same extent. 

Let us not only encourage the use of the tooth-brush, but make 
sure that our patients are so instructed that the brush may be care- 
fully selected and used intelligently without injury to the parts to 
which it is applied. 



Mayor W. D. Cowan. 



O 



RAL HEALTH extends to Dr. W. D. Cowan, Regina, 
hearty congratulations upon his election to the Mayoralty of 
his home city. 



Dr. Frank E. Bennett. 



DR. BENNETT has been re-elected to the Board of Educa- 
tion, St. Thomas, receiving the greatest number of votes cast 
for any candidate in the recent municipal elections. Dr. 
Bennett was chairman of the Board last year, and has done much 
for Oral Hygiene in the Public Schools. 



Prevrntive Drnlistry 
A New Firld of Mrdicine 

FOR yeiirf* <1#nfl"f«» h«»v#> h»^n |»r*»^rhtn« 
Ihr In n 

and m»w *. 

mentii were bajM^d rhiefly on tb« •( 

loMlnR the t(»eth nntl on |>oiiiiiblr i 

and otht.*r dlufittlvt* dljiturlKini-«>ii •! « 

of K»*riiiJ« I 

Now. however. ih« > 

reinforced by the in.,-.,.. 
Ins to the pntlent'ii teeth ' 
uited to piiy to hi* tonxue 

Thin In becauiM bnrterloloic'**- *■' 

covered that the name Kerm v •■• 

decay iin<l !■ •• 

ti-«-fh Miiiy t 

an Rajitnr iiirrr. fn't 
U.;. *.lon of til. k .hi. V ..• Ul 

of Joint Inflnm .o at 

the root of a tiMitn m > * «• 

tr*'"*, Vi't th«» ff«»rn>" t i« 

I 

em phynlclan. when he Aevii a caae oT 
Inflammatory rheumatlitm. lottlui flmt > 
tomtlU. and If he flnda no troubk* * 
ajikM for an X>ray of the teeth 

Thl» Klvea to th -- of i..- 

much Kreater lmi» thnn t* 

formerly received. 




Doctor Thomas L. Gilmer 
Chicago, Illinois 



^ 



m 



OPAL HEALIA 



l»K^^^M i<>N. • \nuhi \s imf "immmio^ mh>~ 




Ma 



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lOnoMo. I I liKI \|{V I'Mf. 



N... 2 



Chronic Oral Infections and Tlirir Kf lalion to Dis^as^ 

in Other Paris. 



Ihomas I.. Gilmer. M.D . D.D.S.. Sc.D. 



Till, knowledge of focal infection in the mouth <ind )aw« as a 
cause of systemic disturbances is by no means nrw. Many 
years before the advent of bacteriology, mrdicaj men oltm 
lecogni/ed the impossibility of curing patient^ i. ...... — .i ... . rr.^«,c 

disorders until iheii mouths were freed from iiii . • 1* 

ing method of treatment of disease de|>endenl U|>on Irsiom ol ihr 
gums and teeth at that time was the remo\al of the lerth ll w«» 
observed that after the mouth was freed from di^ea^r r' 'equrnlly 

followed prompt reco\ery of patients from chronic i-- - i d»tun> 
ances. which before were incurable by other Uealmenl 

I he association of the mouth with systemic dmndrfs aI iKaI early 
day was the result of observation, and no! Uotn any '*rH>w» 

ledge in regard to the subject Ractenologv. a* ^ I IK< 

then been demonstrated, and e\en after the d» i»ac 

teriology into a fixed science, many yean ela|Hed before a cloir con- 
nection was made between cause and effect 

In a series of articles by Miller in 18^1. ^» 

Moulh as a |-<xus «>f Infection." he saui (/' .. <, 

ltt*>l. page f)8<)) : "During the last few year* thr «• 

grown conlmuallv stronger among physicians, ai well ai iKal 

the luim.m mouth as a gathering place and v « 

germs |>erforms a significant role in ihe f»rr«' oi \ai:cu a^'*i1n^^ 



48 ORAL HEALTH 

of the body, and that if many diseases whose origin is enveloped v>\ 
mystery could be traced to their source, they would be found to have 
arisen in the oral cavity." These articles, written a quarter of a 
century ago, were prophetic of facts now demonstrable. 

In 1904, Frank Allport, of Chicago, read a paper before the 
Chicago Dental Society, entitled, "The Relation of Odontology to 
Opthalmology and Otology," in which he quoted from various 
opthalmological and other medical journals, citing numerous cases 
of eye diseases which were secondary to jaw infections. (Chicago 
Dental Review, April, 1904.) 

In 1906, Osier gave your own Hunter credit for having first called 
attention to oral infection as a cause of systemic disorders, and then 
made this statement (Osier Practice of Medicine, 6th edition, page 
440) : "Of the twenty cases of pernicious anemia which I had under 
observation in 1 904, pyorrhea alveolaris was present in more than 
half." He further said: "Certain types of nephritis are also believed 
to be due to oral infection." 

Mr. Hunter, of London, delivered an address at the opening session 
of the Faculty of your McGill University, Montreal, October 3, 1910, 
entitled, "The Role of Sepsis and of Antisepsis in Medicine." (The 
Lancet, London, England, January 4, 1911.) In this address he 
cited numerous cases of systemic disorders which were directly trace- 
able to oral sepsis, and criticized "American conservative dentistry" 
in severe terms. He also criticized medical men for looking every- 
where except the right place — the mouth — for the cause of certain 
diseases. Some American dentists were highly indignant at this 
severe arraignment by Mr. Hunter, and retorted in a manner which, 
in the light of subsequent events, has made them appear in an unenvi- 
able light. 

It was not until Billings, of Chicago, and others, in more recent 
years, systematically took up the subject and connected the clinical 
findings with scientific bacteriological demonstrations, that the true 
relationship existing between oral foci and systemic diseases were 
made manifest. 

Billings associated with himself in this work Davis and Rosenow, 
bacteriologists, of Chicago, the latter now of the Mayo Foundation, 
Rochester, Minnesota. The work of these men has created wide- 
spread interest in the subject and much good is resulting. Many 
valuable reports have been made by them and investigations are still 
going on, developing new and interesting facts. 

Among their first work, diseased tonsils were subjected to bacterio- 
logical examinations, cultures made from the prevailing organisms 
isolated and animals inoculated. Joint, muscle, stomach, kidneys and 
heart lesions were demonstrated in these animals after death. The 
organisms, principally a streptococcus, regained from the animal 
lesions were found to be the same as those isolated from the diseased 
tonsils. Later it was found that abscessed teeth gave the same 



OKAL HI.Al. I H 49 

organisms, and these were found to prrxJucr on ammali umiUr rcmlu 
to those takrn from tonsils. 

Billings says (Journal of the Anicruan A/-/- •' Am<j^ mii-n, ' 
I. I '^13. page 1524): "Acute rheumatism i . ig l>«'rn r'-ro-^r ,^j 
as an infectious disease. Ilie organism has been cir 1 at 

Streptococcus rheumaticus. Diplococcus rheumatKUs. or iVliciococciM 
iheumaticus. With the phrnonnnal work done by Kmrnow in con- 
nection with new m<-thods of bacterial culture in our chnic. we (tac- 
tically always find the organisms in the exudate or in the tissues of the 
patient. We can then make a culture of it. can inject it into animaU. 
|)roducing the disease, and we can reco\er it from the animal again 
Acute articular rheumatism is an infectious disease, due to a form ol 
streptococcus; that streptococcus is s|>ecific in the production of the 
syndrome we call acute rheumatic fever, just as the pneumococcus n 
in producing ordinary lobar pneumonia. It has been |>roved by 
mvestigation that the organism in both acute and rf rheimuUMn 

is hematogenous in its method of infection; the . ^ i mm paMifig 
through the smaller blood vessels of the tissues are caught by the 
endothelium of the vessel, producing cellular proliferation and oKilfuc 
tion of the blood \essel. so that in acute conditions one finds the blood 
\essel obstructed with minute hemorrhages at that |M>int into ibc 
infected tissue.** 

In 1^1 I. {fillings. Davis and myself, in a sym|>05ium in the CKicafo 
Medical Society, presented papers on focal infect ! '• ihr 

following from mv paper (Chronic Oral hifect: i \ d 

Mcduinc, April. \')\1. vol. 9. pp 4W.5()4) < ■■. , ..,.Ur 

abscess is so common that few go through life without one or more 
such suppurations. There are two forms of this chsrase; that whxh 
continually or periodically discharges either into the mouth, noie, 
maxillary sinus, or elsewhere, and the blind ab^rv* whuf) nr^rr .1*. 
charges through a sinus, the pus being abst)rbed by the . . < 

walls of the abscj'SN The former, discharging pus and I .x!-- la M 
indicated, cannot but be prejudicial to health, and the latter. lUc bhnd 

abscess, offers greater danger Its presence is illy un. *-'*^ 'il 

by the p.ilieiil and m.iy be o\erKH>ked by the . .»n. e\t <• 

mouth IS (xularly examined, since it may no! present to the eve iK^ 
clinical evidence of its presence I think twenty-five per « 
estimate of the percentage of jaws ha^ cavttjr* i n-i 

greater havm- is not wrought by such ! * Jll » C*K eilnct 

to the fact that the dosage of bacteria and their \<m€tm is usually 
insufficient, or to the fact that the normal individual l>rcofnes mmmmic 
to the bacteria. Instances, however, are not !• ♦ 

strate that such focuses of infection are instrumeii!.* 

neuroses ami sectmdary infevtu>ns of the eve. ear at 
therefore, when there are manifestations of diseaw \%hKh mA\ ^^ 
dependent on some hx^al focus of infection, the nuxit' ^» 

well as other possible sources, should br > To *i - .■ v 

mav not hold the kev to the ss^lution of l:. ^ 



30 ORAL HEALTH 

'The question which has not been answered, but must and will 
be, is: What is the bacteriology of chronic alveolar abscess? When 
this question and the question of susceptibility and immunity are 
answered, we can better understand the relation which these patho- 
logical cavities in the maxillae bear to lesions in the heart, kidneys, 
lungs, nerves and brain. Here are possibilities not to be ignored. 
Did similar abscesses exist in other bones of the body, their presence 
would demand immediate attention, both by the patient and the 
physician. Alveolar abscess is usually considered inconsequential, 
and when the attention of the profession has been called to it, it has 
generally excited little interest, and has been allowed to pass as an 
insignificant 'gum boil.' " 

The etiology and pathology of alveolar abscess is so well known 
that its recitation in this paper would be superfluous. Its prevalence 
and dangers are now well recognized, and a more extended observa- 
tion leads me to conclude that the above estimate of twenty-five per 
cent, for adults having chronic alveolar abscess is too low. In many 
instances these abscesses are not discoverable except by the aid of 
the radiograph, and in some instances the infected area is very small, 
but no matter how small the area involved, the danger may be quite 
serious. 

In the quotation previously made from my paper on "Chronic Oral 
Infections," I said: "The question which has not, but must and 
will be answered, is. What is the bacteriology of chronic alveolar 
abscess?" At the meeting of the American Medical Association in 
1914 (A Study of the Bacteriology of Alveolar Abscess and In- 
fected Root Canals, Gilmer and Moody, Journal of the American 
Medical Association, Dec. 5, 1914, Vol. 63, page 2023), Moody 
and I attempted to answer this question in a report of a short series 
of examinations made by us at St. Luke's Hospital Laboratory, and 
a similar study has since been made by Hartzel ("The Clinical Type 
of Arthritis Originating About the Teeth," Journal of the American 
Medical Association, 1915, LXV. 1093). We examined specimens 
from sixteen acute alveolar abscesses, eighteen sub-acute or chronic 
abscesses, and eight specimens from the root canals of abscessed teeth. 
In this series of forty-two cases we found the predominating organisms 
to be streptococci. We obtained many graded varieties from a 
hemolitic streptococcus with a wide zone of hemolysis in acute 
abscesses, to a streptococcus viridans in the chronic form. In one 
instance we found the streptococcus mucosus was the prevailing 
organism. After the report of this series, we made other examinations 
with similar results. We are now making a more extended study of 
chronic jaw abscesses with animal inoculation and passage. A 
partial preliminary report is appended below. 

Unless the greatest care is exercised in the collecting of material 
for culture work the results will be valueless. In Moody's and my 
work the gums about the abscessed tooth and those adjoining are 



OR Al. UKAl. I H 51 

thorouK^ily cleansed with alcohol, a stcnl inslrumrnt is used to renKne 
the tooth, and as it i5 removed it is not |)ennilled to touch any |»«rt 
of the month /\ sli-ni (uprt drawn to a fine cal ' d scaled with 

heat IS used to collect the specimen, its large end .■ • '-igiird Hilh 

•leril cotton. Ilie sealed end is broken off and i. and ih«- 

material from the apical |>ortion is sucked into the pipct and lh< 
opening sealed hy fusing; the glass. It then goes direct to the labora- 
tory for culture. 

Here is the preliminary rej>ort referred to al>o\e. made for me 
by my ossociate in this work. Dr. A. M. Moody, bactcrolo^ist. Si. 
Luke's Hospital I his study is being made for the pur|>oie ol defer 
mining, so far as possible, the effect on animals injected with Uram« 
of freshly isolated streptococci from chrome al\e<j|ar aJ>vr%*r^ In 
this work strains of streptococcus viridans. isolated from aUr«>Ur 
abscesses in fifteen patients suffering from \arious patholo^pcal con 
ditions. have been injected into a total of forty-se\en rabbits. A 
complete report of this work will be ready for publication m the early 
summer. 

Since the results of these histological examinations are identical 
with those published in 1914 by Gilmer and Moody, it doe» not seem 
that a complete statement is necessary at this time Ilii* mmh i* 
true, that the streptococcus viridans in every instance is ih'- r,f,-.r>f 
mating organism, and that in only one instance was the st > 
cus found, and then just an occasional colony was |>resent. 

Of the fifteen patients with chronic alveolar abscesses ux h.\ 
pyorrhea: eight had rheumatism, one each acute gastrK i:' ' 
ritis. myorcarditis. mitral enciocardilis. and nephritis l\ 
technique, in a large measure, has been followed in ihrv Mudie« 
The exceptions are two, i.e. (I) The doses of stre|)tococci have, m 
all instances, been less than two billion, and in nnwt • > 
one h.ilf and one billion. I hese are approximate n 
I he .uiimals ha\e been allowed to live a longer lime .r 

I h»- gross p.ithological lesions present in the forty-se%en raW»i' 
arc given below. Ilie microscopical exn n« of t^ \\r rH4 

as yet been com|)leled. but m so far as \ trT\,if - ... . 

gressed. the gross diagnoses ha\e been •'! I 

table of Kosenow in the animals autopsird 
Appendicitis was present in 

Hemorrhage of stomach 44) 

Ulcer of stomach ' ^ 

Ulcer of duoilenum 

Hemorrhage or pus in gall bladtlrr I > 

Hemorrhage in pancreas ' * 

I lemorrhage into Peritoneum ' 

.Aithiilis and \ riiosiitis . "*'' 

F.ndocarditis 
Pericarditis 



52 ORAL HEALTH 



Myocarditis 3// 

Nephritis 30% 

Hemorrhages or other lesions of the lungs .... 10% 

Hemorrhages into the skin 2% 

Tongue 0% 

Eye 4% 

Hemorrhages into jaw 20% 



The hemorrhages into the jaw have not been previously described, 
except in a paper on experimental scurvy by Jackson and Moody 
before the American Association of Pathologists and Bacteriologists 
m St. Louis, April, 1915. These hemorrhages occur beneath the 
periosteum of the lower jaw before the central incisors. Occasionally 
they occur on only one side, but may be present on both. 

This series is too small to draw any definite conclusions. They, 
however, indicate a certain amount of selective localization for the 
streptococcus viridans isolated from chronic alveolar abscesses. To 
be more specific, these organisms produced gross evidences of muscle 
involvem.ent in 60%, joint and bone, aside from the jaw, in 40%; 
stomach in 40%, kidney in 30%, and jaw in 20%.* 

We occasionally find what I have termed atipical alveolar 
abscesses, the lateral abscess of black on the sides of the roots of teeth 
having live pulps. 

Black believed that these abscesses were due to acute pyorrhea 
alveolaris attacks, the infection extending from the gingival border 
root-wise through a narrow channel on the side of the root. 

Since Moody and I have found in 20% of our cases sub-periosteal 
hemorrhages in the jaws, I am inclined to believe that similar hemor- 
rhages may be found in the peridental membrane. If hemorrhages 
are caused by the streptococus in the periosteum, may it not cause a 
like condition in the peridental membrane as well? 

Since the area involved in hemorrhage may later become abscessed, 
then if the peridental membrane participates in Hke hemorrhages we 
have a seeming scientific solution of the atipical alveolar abscess. As 
yet we have not examined the peridental membrane for hemorrhages, 
but intend to look for them in this organ. 

Rosenow's work is the most interesting of all that has been done 
m connection with the subject of focal infections. Reports of much 
that he has done may be found in the Journal of Infectious Diseases 
and the Journal of the American Medical Association in the past 
three or four years. Rosenow says (Journal of the American Medi- 
cal Association, May 1, 1915, page 1524): "The demonstration 
of streptococci in the focus of infection at the time of an attack of 
appendicitis that has affinity for the appendix when injected intra- 
venously into animals, it seems to me, is good evidence, together 
with all the other facts, that the growth of the organism in the throat 
or in the focus of infection is primary, and that the disease in the 

*The atoove experimental Avoik was done in St. Luke's Hospital Laboratory. 



ORAL HKAl/IH 53 

appendix IS a rwull of ihi*. nol by ihc swall wing of b«ctcna. but 
by rmbolic infection . getting into tbr circulation and 6iidnig hi the 

ap|)cncJix a favorable 5pot for growth.** 

He further says: "Wc have heard much in regard lo the nsport- 
ance of various foci of infection. Ilie breaking of (he contintnty ol 
surface, the epithelium of the skin, the breaking of the conlinuily cA 
mucous membranes anywiiere should be regarded as a »mou% malter. 
Vt e know the relationship of slight abrasions lo highly %■"•''♦»» 
streptococci infection. After demonstrating the presence of b . 
of low virulence in this type of infection in cases of cholecyslitts .v : 
appendicitis, why not believe they are also im|>ortant> Ilie f«- • 
is not only the place of entrance, but also the infection atrium I 
transmutation of streptcxrocci has been established In one insla, 
there is an affinity for joints, in another for the ap(>end]X. and in *' 
others for the stomach and the gall bladder Iliesc lyi>r* of strei^- 
tococci are so much alike in their cultural characterislKs and mor|>ho 
logy that it is difficult to differentiate tliem; but when in>ected as 
isolated, they are different in their actions in animals ** 

I he radiograph is essential to the best understanding of ihr con- 
dition of the jaws. I he faradic current, as recommended by Pnn/, 
is the best method of definitely determining the life of the loolh p* ' 
provided it is nol too much enveloped by gold or other mciAU. i" 
r<Kli()gr<i|>h teeth having live pulps, in seeking out jaw abtCCHCS. i» 
an unnecessary expense to which to subject a patient, and the extent 
of pyorrhea pockets may usually be determined very accurately b> 
the use of delicate steel probes All teeth having dead pul|H. whKh 
promise any hope of being saved, should be radiographed '•>' ?* ♦■ 
pur|)Ose of determining the presence or the absence of rod 
the extent of the abscessed area, if present, and the extent ot tt.r 
destruction of the peridental membrane. If the apKal area r 
is inconse(|uential. then treatment may be undertaken ihr- . 
pulp canal by medication If the apical |>ortion of i\\r [.» • 
denuded of its normal investment, even lo a tlighl degree, then that 
part denuded is dead tissue and must remain »uch, since the fx- 
dental membrane is an organ of speciali/e<I tissue. whKh >%hen omr 
destroyed is never reformed. leaMiig the denuded |x»?'— " ' . /-»i.rM?,-- 
and dentine permanently necrosed L'niike nc^ 
necrosed end of a root cannot be exfoliated If !»*> great an exieni 
of the root be denuded of its peridental membrane to indicate Irr^' 
ment by medualKMi through the root canal, then the nerroM^ . y ' 
may be resectetl, the abscess curetted. an«l 'hr u^rfulfif-i* oi the t.* • 
in a majority of cases, be preserved I thts tfralmrni 

is not e<iually applicable lo all teeth Ke»et:lKJO n |»aft 
applicable to the upper incisors, cuspid* and bicuM^: ^* ' "* 

correspondiiiK lower teeth, rarely to the up" "^ ' "* ' " '^-'^ 
callv never to the lower "i.Iu*. owing to th' »^ 



54 ORAL HEALTH 

If roots to be resected are infected or imperfectly filled, then these 
conditions should be corrected before the operation. All teeth whose 
peridental membrane is largely destroyed should be extracted, as no 
treatment can cure such teeth. 

As before said, any apical abscess, it matters not how small, is a 
source of danger. So long as vitality is high, the product of a small 
abscess may do no visible harm, but a slight trauma or a lowered 
vitality may change seeming immunity into susceptibility to even 
small dosages of bacteria, or their toxins, with secondary manifesta- 
tions resulting, often of a very serious nature. If this is true, it is 
our duty to keep close watch over our patients and eradicate every 
focus of infection found in the mouth. 

With knowledge of Rosenow's work on "Elective Localization 
of Streptococci," we can see the possibilities of the danger of these 
streptococcus infections of the jaws, and since the mouth is a part 
of the human anatomy, for which the dentist is especially respon- 
sible, a grave duty rests upon him. So far as possible he should 
prevent alveolar abscess and pyorrhea alveolaris, but if these dis- 
eases are present they should be eradicated, even if it necessitates 
the removal of the teeth involved. Teeth are valuable, but life and 
health are paramount. 

I am skeptical about the permanent cure of pyorrhea alveolaris 
after deep pockets have been formed. If the pockets are not so 
deep, but that cutting away of the gums overlying will eliminate the 
pockets, we may, in some instances, by the combination of this with 
other treatment, preserve the teeth without jeopardizing the patient's 
health or life. I would emphasize the importance of completely 
eradicating the pus pockets, otherwise there can be no hope for a 
condition which is safe. 

The radiograph is well recognized as an important aid to 
diagnosis in chronic jaw infections, but unless the pictures are skill- 
fully made and properly interpreted, one may be led astray by them. 
The angle of the exposure of the film, in its relation to the light and 
the relation of the film to the tooth, are both important factors. The 
buccal roots of the upper molars, in some instances, appear to be 
within the maxillary sinus, because the light was superimposed to 
the floor of the antrum. Indeed, in many instances, it is difficult to 
make a picture of some of these teeth which will afford accurate 
information as to the condition of the apices of the roots. One should 
alwavs remember that radiographs are simply shadow pictures, 
therefore show only the apical, mesial and distal parts of the roots. 

A few of many similar clinical cases which have come under my 
observation will be cited later, which seem to indicate very clearly 
that mouth foci is instrumental in causing systemic disorders, since 
on the removal of the original focus of infection, the patients have 
fully recovered. It must not, however, be expected that all patients 



OK A I. HKAL I H 55 

with arllirilis deformans and with ollirr ly^trniK: di*atdftt of Umm 
slandiiiK ^^i" ^>*' t'urrd when ihr oriKinal f*x:u» is rciiKncd, or thftl 
there will be inHn<(Jiale cure on iheir removal, tirnr .irifl tdUft ir*.^i 
mcnt is often necessary. 

I thirjk il may be stated with considerable accuracy that ihe r 
chrome the condition, the greater the time necessary for a cure after 
eradicating the focus of infection; and also that in a ma|ortfy ol 
those cases which do not yield to the remo\al of the focal cau«< iKe 
condition has existed so long that changes ha\e taken place in iKr 
organ or parts involved, which make it im|>ossible for »uch organ or 
part to regain its normal state 

Vaccines have been cjuile rxlcnsively used in the I ' .f 

various diseases, and m som<- instances marked impro. . «• 

been observed. No hope for help from vaccines should Ik- rv i. 

however, until the focus of infection has been removed, and e%en 
then the vaccines employed must be the right strain, otherwise no 
good should be anticipated, and even harm may be done by iheir 
use. I he use of slock vaccines is only a guess that ihe right strain 
will be included among the various strains employed. SiKh vaccines 
are not unlike "shot gun" prescriptions, in which a number of dnici 
are combined with the hope that some one of the ingredients may 
be the desired one needed to effect a cure. 

HiHings says (Journal of the Amcruan Xfcdical Anociation, May 
I. I'M 3. page 1324): "For acute rheumatism vaccine* have beeo 
used If we are going to follow any principle in treatment ol %ac- 
cination. we must stop and ask what these vaccines are ex|»ected to 
do. In acute infectious disorders, vaccines have not pro\ed efbcaci* 
ous. When the living organisms in the l)ody do not excite eiMHifh 
antibodies, it is not reasonable to inject more dead bacteria into the 
tissue to excite the defences. Phylacogen or rhe- *fen 

j)re|).irations are being used all o\er the country for rli» wii..tii-.iii In 
the ad\ertisemenl of a certain pharmaceutic firm there is a report of 
15.000 cases of rheumatism in which recovery ensued m 12.000 
with the use of rheumophylacogen I have l>een fvactising met! 
for thirty five years, and I have not seen patients die from .^ 
rheumatism per se. I have seen them die from ''"- »'-.">«-^»'- »^ ^ 
of heart conditions, later in life, etc My prol 
that I have not a go<Ki opinion of these pre|>arations 

Relative to stock vaccines. Kiwenow says (I < 

<(in ^fclli^a^ Assoiiiiiinti. Mav I. I*>I3 » • i 

to hope to get good results from strept *' 

the drug store and using them for these \anous f 

will strept(X(Hcus vaccines, manufactured by various >' 

laboratories, do in each specific cAse> .A ^ 
opetl .md given for each specific disease t . .. . 
shouUi be U5e«l In .>r.lri ti^ h.i>e aulogemnis ^.^ 



56 ORAL HEALTH 

organisms must be proved; then you can proceed to treat the case 
intelligently." 

A few cases which have come under my observation may serve 
to illustrate the baneful effects of focal infections of the mouth and 
the remedy which brought about a cure. 

Mr. A., aged 76, had an attack of rheumatism of the ankle and 
joints of the foot. He came to my office by the aid of crutches. I 
found two teeth badly abscessed. These teeth were removed and 
good drainage secured. One week later he was able to walk with- 
out crutches. He has remained well after a period of seven months. 
The rapidity of this recovery is unusual, and a like rapid recovery 
should not be generally expected. 

Mrs. R., aged 70, had had sciatica for a year. The ordinary 
treatment for such cases was not helpful. She had pyorrhea about 
most of her teeth. The pyorrhea pockets were so extensive that 
extraction of the teeth was indicated. Her sciatica was rather worse 
following the removal of the teeth, and it was not until six months 
had passed before she was free from pain. One year has elapsed 
since the extraction of the teeth, and for half of this time she has had 
no pain in sciatic region. 

Mrs. B., aged 60, had arthritis and neuritis extending over a 
period of two years. No focus could be discovered other than in 
the mouth. Had many crowns and bridges. Mechanically, this 
work was well done. Abscesses at roots of several teeth, gingivitis 
about all crowns. Pockets between some of the molars. Roots 
had not been very successfully filled. Teeth were removed. Con- 
J^ dition did not improve for six weeks, then gradual improvement for 
six months, when patient was freed from all pain and discomfort. 

Mr. S., aged 26, referred to my clinic for surgical treatment of 
large abscess in the upper jaw resulting from infected tooth. Patient 
had temperature of 100°, was anaemic, skin pale, eyes dull; had 
not felt well for several months. Removed teeth and cleaned out 
large abscess in the bicuspid region. One week later patient much 
improved in appearance, temperature normal, color better. Two 
weeks later he was seemingly completely recovered. 

Mr. K., attorney. Health steadily failing for five years. Was 
pale and anaemic, "extremely nervous and easily upset.'* Digestion 
poor. Might be considered a neuresthenic. Physician could find 
no focus of infection outside of the mouth, and sent patient to me 
for oral examination. My examination discovered deep pyorrhea 
pockets about several teeth and abscesses about the apices of others. 
One of the abscesses extended from cuspid to cuspid on upper jaw. 
Removed abscessed teeth and curetted abscess cavities. Extracted 
the worst pyorrhea teeth and treated those less affected. Improve- 
ment apparent in a short time. In three months was fully restored 
to health, and still remains so. Gained much flesh, and is no longer 
dyspeptic or "nervous.** 



ORAL H KALI H 57 

It must not be forgotten that the {)rimary focus of an aUcoUr 
abscrss may at time br the lon^iU. jomt. or olher part, and the )aw 
infection secondary to these. S^mrtimr^ an abvr** form« at the rnd 
of a TwA, which has no relation to the mouth In such ca^cs the 
infection must be secondary, the organisms coming through the blood 
streams or lymphatics from a primary focus elsewhere 

Since dentists now know thai mcuth fr>cu*rs of infection 
or later may cause secondary manifestations of more or JcM 
cance in other parts, what will their attitude be toward the tiibicct> 
Will they continue the retention of loose, incurable, pyorrhca-tn- 
fected teeth? Will they continue the use of badly infected roots 
as piers for bridges? Will they ruthlessly desiro ' * in sound 

teeth that bridges may be inserted, knowing the ...;. ..iv of per- 
fectly filling most roots, and the impossibility of filling some > Mill 
they ignore the dangers from incurable abscessed teeth and retain 
them indefinitely in the jaws? Will they continue to set 
which are unsanitary? these are pertinent questions for us «ii 

Resume of Discussion ol Dr. Gilme r*s Papf r. 



Dk M( Donach. I oronto: 

DK McDONACH complimented the -••' *- -• -' 
lence of the paj er. referring to the ^ 

absorbing topic among thinking men in both the denial and 
medical professions. 

A summary of Dr. McDonagh** remark* ft)lhi\\« 
was made to the lack of dental instruci"" "• "^ ■' «' 
the prediction made that when such t . 
medical profession will not be found swinging over from the 
of entirely ignoring oral conditions to the other extreme of ■ 
every ill of the human bmiy to mouth ir^ * i*. Notuir \ : 
l:owe\er. there has seemed to be a dt>i ;i on the i » ' * ' 

public to take the word of the physician rather than ' 
covering these matters, but such an attitude rapidlv |wii»c% «%%«■ 
dentists more fully understand their i 

in one of Dr C*ilmer'* statements tii<i< i- .m 
to have a haemoly/!ng organism \>e iiuisl hrt\' 

that if the abscess becomes of long 9tanding it will contam Imt the 
strept(K0Ccus \iridans. Dr McDona«h said that if th^l v 
Dr. Hunter would ha\e to look further than he h** «l«»4>«- ■ ' ^ ^ 
explanation of perntcious anaemia .aiul manv i^f f'*- - »'• « ^» * S 
had come uiuJei the speaker's itersonal n«»ticr uoi. 
I^lained anew, and the cjueslion was asked Dr C*ilmer it he had 
n)ade investigations sufficiently extensive along thi» hne Ir ♦ an 

opinion. 



58 ORAL HEALTH 

I^osenow has proven that certain strains of streptococcus have 
affinity for certain tissues, and taking the w^ork of Rosenow and 
combining it w^ith the work of Hartzell, we see that the organisms 
which are confined at the apices of the roots are, or may be, re- 
sponsible for certain specific kinds of systemic infection and that 
these organisms are not capable of producing certain other diseases 
which might be attributed to apical abscesses. By the use of this 
knowledge, a dentist who understands the subject might be able 
to say to the physician or patient, this disease can or can not be the 
result of alveolar abscess. 

The paper touches upon another subject which is intensely interest- 
ing and of far-reaching consequence, viz., the transmutation of 
organisms in the oral cavity and the oral tissues. Dr. Goadby does 
not agree with Dr. Gilmer that the streptococcus is the only specific 
organism for rheumatoid arthritis. 

In the matter of infection frr^i suppurative perioclasia (pyorrhea) 
dentists have frequently marvelled at the small number of cases of 
general septicemia which result from such supposedly large areas of 
absorbing surface found in suppurative periodontal pockets, but, 
said Dr. McDonagh, the amount of absorbing surface is not nearly 
so large as it appears, on account of the covering of mucous mem- 
brane with which nature lines the pocket. 

The speaker confessed to being a little bit puzzled by Dr. Gilmer's 
eulogy and condemnation of radiographs and could not agree with 
him in all he said regarding them. Experience teaches that radio- 
graphs will not always truthfully tell the extent of destruction of 
periodontal tissues nor of the pericemental membrane, nor was it 
always necessary to know how much of the pericemental membrane 
is destroyed. Notwithstanding Dr. Gilmer's statement that the 
pericemental membrane is a specialized tissue and will not rebuild. 
Dr. McDonagh said he could show slides and sections that plainly 
indicate that pericemental membrane will rebuild and that cementum 
will rebuild under it. 

Attention was also directed to the fact that dentists, through faulty 
manipulation and inability or neglect to observe pathological 
conditions in the mouth, might cause in their patients loss of health 
or of even life itself, and reminded those present of Dr. Gilmer's 
question: — What are we going to do about it? Dr. McDonagh 
urged that every practitioner put the question to himself and honestly 
answer it. 

Dr. Arthur Day, Toronto: 

Dr. Day, at the outset, stated that he was not going to discuss 
the paper from a scientific standpoint but from a practical viewpoint 
and referred to the paper as being so very complete that for an 
oidinary practitioner to re-state the facts would add little value to 



ORAL HKAI. I Y\ 59 

the discussion Dr. Day asked the questions In ihti »ub>ccl ol 
gcnrral systemic infection, where does the ordinary |iraclition<r comr 
in> What IS h<- supposed to know al>out ' eases and what is 

he .supposed lo do .iboul them> and pro • ^wer in the 

following words: I here are two cases . . ,jw\e{\iir ,,l 

such disturbances may be of value: in the early stages ol 
infection, before the patient has consulted a physician, and in ihr 
later stage where the physician has diagnosed the dis^ d is 

hunting for the foci of infection. In the latter stage h« ;* iKe 

patient to the dentist to see if there is infection in the mouth, if the 
dentist finds it. he eradicates it. extracts, or treats the teeth or fww 
or whatever is necessary If he finds no infection he rqxirts that fact 
to the physician. 

In the earlier stage of griural infection, however. »! i'-«— • 

presents with an infected mouth we should look for s% , • 
general infection A muddy complexion, low fever. * 

and a()petite. if there are muscular pains or digestive dislurl>ancrs or 
( onstipatioM. the (hritist is doing the patient a service in advising that 
I hey should see a |)hysician. 

If you think there is an absorption of pus into the blood ftream 
it is your duty to insist tluit the patient go to a |>hysician vnthoul 
delay and have a blood count made When general treatment n 
commenced by the physician or in conjunction with the dentist. (aikJ 
this IS lh<' practical part I wish to particularlv s|>eak alx^'' 'he 
dentist should be warned against making any promises to th^ tl 

regarding a cure. Don't have the patient think that because a loolh 
be extracted they will be rid of their ailment Rest assured that the 
physician makes no rash promises of a cure PhysKian* have nd 
been in the h.ibil of guaranteeing their work, as some dentists have 
We dentists have always been used to a |>ositive diagnosis and an 
almost positive prognosis, but as we gel into treatment of this »* ^ 
acter we must be more careful, we are more w '\ I hrrr m^v 

still be a focus somewhere else after the mouth . --" ^^ • ' »f 

infection lo give false promises or to have the | .1 I 

in lack of improvement in the general condition after the mouth roo 
dilion is cured, is only to give oral infection, as a cause ol 
infections, a set back, and t(» son)e r\trnl iu*lifv its beuif caurtj ^ 
"fad " There are manv physicians v\ho call it a fad and u^tne c^l 
the leading ones think that the extent lo v%h»ch il is l>r 
a fad. Among the latter is Dr. Caven of our o%»*n cilv 

As for the serum treatment, my advice is when it tH 

from under.** Such treatmrnt is onlv in the e\ A 

vaccine is of no permanent value unless all the f Ma 

if all the foci are removed then there is little need fof v^ In 

studying this subject and in reading the vast ar 
upon It we dentists will have to reason out the jicooienu i^ *^'^ 



60 ORAL HEALTH 

selves; speoal.sts and research workers are very apt to become over 

"1";'tpeat the question, where does the dentist come in> 
Pe sonallv believe the dentist's chief work .s along the hne ol 
™i He must recognize those incipient irr.tat.ons wh.ch cause 
mltions .n the mouth. Once started, an mfect-on w.th °cus " 
some other part of the body may be contmued by the smallest area 
oMnfecton in the mouth, such for instance as a c°mparat.vely 
si a low Igivitis. Dental operations must be such that they will 
not ca^se gingivitis, or trouble at the apices of the roots. Otherwise 
denUstry will be blamed for many systemic infections, and justly so. 
mother prophylaxis is necessary, or of value, certainly this may 
be said -if there is a reasonable chance that it may remove the 
cL e tf moSh inflammation, it is well worth the t.me and energy 
Tukes to perform. For in an infection of any kmd, an ounce of 
prevention is worth a pound of cure. 

Dr. a. E. Webster, Toronto: 

Dr Webster, in continuing the discussion, said that he wished 
to express pleasure in hearing Dr. Gilmer present this subject in such 
a san'e manner. Most essayists on this -b^^' f- -'-""f,;'*!! 
one way or the other. Dr. Webster remembered when a student at 
Rush Medical College, the late Professor Senn often remarked 
"oatients who have a sudden rise in temperature should be carefully 
exammtdtr some local point of infection." As a dentist it sur- 
prised the speaker beyond measure that upon no occasion did Pro- 
fessor Senn suggest a careful exammation of the mouth for local 

foci of infection. ' r • • i • u i ^r. 

Dr Black in discussing alveolar infections in his new book on 

patholoay closes a chapter with this significant idea, 1 here are too 

many of my patients who are now dead, who were treated m a 

conservative way." i i t^ r>i f^ 

It is a common practice and the one advocated by Dr. Gilmer to 

treat chronic alveolar abscesses in which the apex of the root has 

lost some of the peridental membrane by amputation of the end ot 

the root Dr. Webster had never been able to understand why the 

root canal should be filled and then the amputation made, because 

the reason for the abscess in the first place was an infected root and 

the difficulty in sterilizing is great while ever the root end is m- 

fected Dr. Webster declared it as his judgment that the root canal 

, should be left open until after amputation, when it can be 

mechanically as well as chemically cleaned out and the root filling 

inserted, having the end of the root in sight, so that there may be no 

mistake about it. , r u • 

Dr. Webster asked: What is the bacteriology of a chronic 
alveolar abscess which has burrowed a cavity sometimes as large as 



OKA I. HKAL I H 61 

a Brazilian nut? and rrmarkcd that in such cases thcfc would t€rm 
to be little or no inflammatory reaction. No amount ol wailung 
through the root, out through the sinu^. would bring about a cure for 
5ucli ca5(*s. I Ik* .spcakrr was especially glad to »ee lo maJiy caics 
of root filling extending through the r(K;t canali and an abicc» rtill 
present, because we have been told recently that there is no hann in 
pressing foreign substances through the end of a root. N.ifure don 
not lojrratc forrign substances in the alveolar lUsun any bettcf than 
in any oilier part of tin- Ixxjy. 

Dk. F. Arnold Clarkson. Toronto: 

It has been said that the medical profession considered oral f<- 
as more or less of a fad. Unfortunately this is true, but not a * 
gelhrr in the way it was meant S)me of us are • ' ? ' ' 

nienilnr the blue-glass cure and lirown Sequard's . .. 
which are now nothing more than an echo down the c 
At |)resent we are just getting through an epidemK of vaccine 
Rvery kind of disease must be treated with dead bacteria and of 
course when the eiitluisiasm had worked itself out. wr wrrr *•• — '• 
dis.ippumled. Perhaps the fault was in the \accinr. |>rfhaj»^ 
selves. Now we have an epidemic of tooth-pulling. All dwea*e^ 
r«riginate in the teeth, therefore e,xtract the teeth. Montaigne, the 
French satirist, charged tin* doctors of his t»me with l>eing Priests of 
a Hlocdy Moloch, but now his shaft could be more irti'^^^'Mv .f.f^i 
ed against the dentists, since medical men have prai 
to l)lr((| their patients. [dentists are certainly extracting a great 
many teeth, both healthy and diseased. 

What IS f|«- iclalionship between the dent; ' in! h\*ui.%n> Dr. 
C l.irkson illu>lr.ilcd bv a specific instance .\ juiLir:' • fn*^ t«> -« 
inedu.il man who is filled with the idea that all the troi. 
in the teeth. The physician sends the patient lo a dentist with otiU- 
to extract all teeth, heallhv and diseased Sliall the der 
his orders? .Shall he extrail teeth whuh hr knows lo U . 
In one case Di Clarkson knew of. three different denial » 
lefused to take out the teeth On the other hand, he Had ut 
care a man whose teeth were in excellent condition IhjI who h«»i 
sciatica. The phys'caii considered the teeth th^^ 
the dentist extracted them I he result i* 

edentulous but still has siiatua Oher examp 
too. that have been recorded at the College In*: : , and m other 
ClinUs. that simply make one wonder where lhe«e ihingt arr gong 
to slop. 

Dr Clarkson conlmumg. *aid. Dr f'-''^^*-' rrfrfrr.l To f>f Hrm^ 
now. who IS perhaps ihe greatest li\ 

and who has done a great deal lo apply his resuhs lo the k' 
of the sum total of human suffering He has found the ftreptocx^ui 



62 ORAL HEALTH 

in many different diseases. A patient may have an endocarditis and 
pyorrhea but it does not necessarily follow that one is the cause of the 
other. Yet one who doesn't understand Rosenow's work advises 
extraction. Good teeth and bad teeth have got to come out, as he 
understands the pathology of the dual condition, and the dentist 
becomes an accessory. This is what is actually occurring in this city, 
and in the end, these patients still have their local manifestations of 
the disease. 

Dr. Clarkson's own personal opinion as to the ethics of this 
relationship between dentist and physician, is that the dentist should 
be treated like any other specialist-consultant. The dentist should 
give his report as to the conditions he finds, and the physician govern 
himself accordingly. 

One reason that we have such ruthless sacrifice of healthy teeth 
is that the good old family dentist is passing away in the cities. The 
specialist is the rage just now and there are men who do nothing else 
but extraction. They have no opportunity to study the conditions 
fully, whereas the family dentist would have made an effort to save 
some, at least, of these teeth. In every case there must be a careful 
study of the case from every aspect. 

Dr. Clarkson was glad that Dr. Gilmer cautioned against the 
extraction of too many teeth at one time and said he thought one of 
his patients had a recurrence of nephritis because of failure to ob- 
serve this and said he would be more careful in the future. 

j 
Remarks by Dr. Gilmer in Closing Discussion. 

I feel highly complimented by the kindly spirit shown me by those 
discussing my paper and I also wish to thank all of you for your 
generous hospitality during my sojourn in Toronto. 

I did not come here with the thought of teaching you anything 
new on this important question, but that we might compare ideas in 
order to get each other's viewpoint and thereby obtain inspiration 
which will be helpful. Dr. McDonagh spoke of my reference to 
hemolyzing organisms in acute alveolar abscesses. In Dr. Moody's 
and my study of jaw abscesses we found the streptococcus 
hemolyticus in acute abscess and the streptococcus viridans the pre- 
vailing organisms in chronic abscess. In our first series, though not 
large, the findings were so universally constant that we believed that 
it represented what might confidently be expected if a much larger 
number of specimens were examined. Later studies have borne out 
this conclusion. 

As Dr. McDonagh has said. Dr. Rosenow believes that certain 
strains of the streptococcus have affinity for certain tissues, while 
other strains have affinity for other tissues. If this is true, and we all 
have the greatest confidence in Dr. Rosenow's statements, then the 
organisms of apical abscesses, through changes brought about by 



OK A I. HhAl. i H 6) 

rnviroiimriit aftrr escaping from the original foctii. may br to 
t hanged thai thnr selective nature may fit them m one mslancr lo 
attack one tissue and in another, another tissue. If thi« is true ihr 
dentist cannot say to the |)fjysician or the patient thai thr ofnani%m» 
of an apical abscess are capable only of causing this oc that diw-f- 

What the pa|)er said about radiographs ought not lo be conUr. 
as a condemnation of them M'hat was meant was that ihey could 
not always be depended upon lo reflect the true cor " • 

When patients are referred to the dentist by lli. j.n. 
dentist should assume the role of a consultant, examine ih*^ » i J 
report the conditions found, with recommendations as lo what should 
be done. In no case should the physician send a |>atient to the 
r!<-i)tist demanding that certain operations be i ' ' any more 

than he would send a patient to an opthalmolo^. . ;: " l-'nafKl 

to enucleate an eye. It is monstrous to think that |4i> . . a* 
indicated by Dr. Clarkson. will order the extraction of good heai" 
leeth. or that dentists will become a party to such (iraclKe 

Dr. Webster does not approve of the recommendation iii ihr (m(>eT 
that roots to be resected should first be disinfected and the canab 
filled I he method which he suggests may be followed, but that 
indicated in the paper seems preferable in the majority ol cases. Il 
is not desirable to retain dressings in the process wound sufficirnll. 
long to pernnt of thorough disinfection of the canal. NXi'hen the ruoC 
is cut off it is easy to see if the canal is filled. In case of weefHnft of 
a serous fluid into the canal from a carious area in the |woces», ' 
the apical end of the canal should be filled at once, with disinfe> ' 
following NX'Ik'I) there is great destruction in the aUeolar fim^cM 
at ends of loots it is due either to a cyst or canes of the l>one. wliicn 
is a suppuration osteitis. Cyst fluid, when the C)rst walb ha%e ocl 
broken down, is sterile We have made no examination ol iKe 
bacteria of carious cavities in the alvetilar pnx-ess It ha» \yrm 
thought by some that such cavities are due to the tr*— '- ^v-^^- 

Dr. C'hukson recogni/es the presence of fadisis in n\< 
are also to be found in dentistry. In the forty years thai I h.^ 
in dental practice there has never been a time when ihey wr 
evidence. One must be discriminating in hi* conclimon' 
new theories. It is unsafe to accept everything offered, r 
il appears plausible On the other hand it is n»^ \%im- to ff|r<t v^ 
out consideration the findings resulting from careful wotk by good 
men I well lemember the lime when some medKal men ol no r 
ability, rejected the geim theory of disease 



Local Anesthesia with Use of Anocain. 



B. R. Gardiner, D.D.S., Toronto, Demonstrator in Extrac- 
tion, Royal College of Dental Surgeons. 



FOR years members of the professions representing the heahng 
art have been in search of a substitute for cocaine as a local 
anesthetic. In spite of the fact that the anesthesia produced 
by cocaine is perhaps ideal, it is undesirable because of its toxic effects. 
At this point it might not be amiss to summarize the qualifications 
of a local anesthetic: 

1 . The drug must produce insensibility to pain in the desired area. 

2. It must not be irritating to tissues when injected; must not 
produce any tissue lesions or after effects, such as pain or sloughing. 

3. The solution to be injected should be isotonic with fluids of the 
tissues, i.e., should contain sufficient sodium chloride to make a normal 
saline solution. 

4. It must be capable of being combined with adrenalin. 

5. It should be capable of being sterilized by boiling. 

Ever since the toxic effects of cocaine have been noticed, numerous 
substitutes have been introduced. Many have an advantage over 
cocaine inasmuch as they are less toxic, but usually the anesthesia pro- 
duced is inferior. The more prominent of these, summarized by Dr. 
Herman Prinz, are as follows: 

"Tropocain is less poisonous, but also less active than cocaine, it 
completely destroys the action of adrenalin; the eucains partially 
destroy the adrenalin action, they are, comparatively speaking, 
equally as poisonous as cocaine; acoin is irritating to the tissues and 
more poisonous than cocaine; nirvanin possesses little anesthetic 
value; alypin and stovaine are closely related, producing severe 
pain when injected, which occasionally has resulted in necrosi?. 
Quinine and urea hydrochloride reacts strongly acid, and as a con- 
sequence severely damages the tissues in injected area. Novocain 
alone fully corresponds to all of the previous mentioned qualifications 
of a local anesthetic." 

It is now impossible to obtain novocain in Canada, hence it has 
been necessary for us to look for an anesthetic which will be pro- 
curable at all t'mes. True to the prophetic declarations of many, 
the war has already stimulated Canadians to prepare and manu- 
facture articles for which we were at one time dependent on other 
countries. In the field of local anesthesia various substitutes have 
been compounded to take the place of cocaine. The one of most 
recent manufacture is anocain. It is a Canadian product, obtain- 
able in tablet form, containing adrenalin and sufficient sodium 
chloride to give a solution that is isotonic with the fluids of the tissues 
when used in 2/^r solution. 



O K A I 1 1 1. A L I H 65 

I HI. Inh'oktance of An Isotonk .Solltion. 
For the successful hy|>odcrmic administralion of a local ikne%ii ■ 
certain |)hysiological and physical laws should be taken into con- 
sideration. According to lioyle Van Hoff law two solution* of sab 
rcparalfd by a pcrmrahir animal mrmhranr. will no! remain »o, 
l)ul a currrnl is sot up which conlmur^ until thr 5olution« .itr .,f muiil 
density; they are then said to be isotonic with each ■ >y 

this process that plant cells are able to o)>tain moisture from ihc 
outsici<* world, and lhi«^ same phmonirna i^ prr<*rnt in thr inf- .« 

of fluids between the tissue cells of the Inxiy If ^implr .... rd 
water is injected into the tissues only su|)erficial anr^thr^ta if 
obtained, the tissues become macerated and death is the resufe. 
Solutions containing less than .09'' of sodium chloride prodiKe 
shrinkas^e With a |)roper physiological solution absorption Imkn 
place more readily, the injection is accompanied b\ \r« i.Ain and 
results in less injury to tissues. 

I HI. .\i)DinoN OF Adrf.nalin. 

Adienalin. when injected into the tissues. tem|)orarily raises iKe 
blood pressure by causing a constriction of the smoolh muscle coal 
of the peripheral vessels. When adrenalin is added to ihe local 
anesthetic, the anesthetic action is greatly increased i' ' 4 

and the absorption of the drug is prevented. Acco;. ;...». ; , », 

adrenalin has a specific action upon nerve tissue and prepare* .! to 
take up the anesthetic more readily. Adrenalin, combined with mn 
anesthetic injection, increases the duration, giving a greater lennln 
of tiriH* to opj-rate. 

As stated above, anocaine is prepared in moulded tablets cor- 
taining sufficient sodium chloride that when a tabirt is dissolved m 
I c.c. of distilled water, a physiological solution is ready for ire. 
This will give 2' • solution. 

Administration' 

No matter how good the anesthetic. |>rrfn-t 
f.btained without its intelligrnt usr llir infi'" » 

nui.sl Vv ptrfoiinrd with laie. as mechanical i vl 

oftentimes the blame has been laid to the an- I He UiKtesI 

asepsis must be maintained If carele^^new is |»cfmilted in anv one 
part of the operation the result is a failure It ' ' 
one broken link and we know the result \ ^ 

till- \afiatioiis in ihe density of thr bon\ pi -I 

the jaws, through which we wish the anothelK solulmn lo |»at». and 
an accurate knowlrdgr j>f the courM* of the nerve* is I 
obta'ninvT perfect anr^lhrsia ft is 
art'cle to e\en discuss the last tw» 
necessarv and this may be obtainetl fnuu .\ if«*»Hl -i 
lomy. However, a few practical suggestions may be wichKkd ai 



66 ORAL HEALTH 

to the care of the hypodermic, the preparation of the solution, the 
field of operation and the administration of the anesthetic. 

Sterilization of Syringe. 
All metal syringes may be sterilized by boiling. Leather washers, 
of course, should be removed. After boiling, a very thin film of 
carbolated vaseline may be applied to the piston to facilitate an 
easy working action of the syringe. It is unnecessary to boil the 
syringe after each operation unless it has become contaminated by 
pus. To wash out repeatedly with alcohol and to dry thoroughly 
with hot air is sufficient. The writer favors the practice of keeping 
the point of the syringe submerged in a 25% aqueous solution of 
zycol. A bottle with a nickel top for this purpose may be had at a 
dental depot. When the syringe is removed from this, it should be 
rinsed in sterile water to remove any trace of zycol, as it is very 
irritating to the tissues. Zycol does not corrode the metal; on the 
contrary, because of its lubricant nature, it keeps the syringe in 
splendid condition. 

Preparation of Solution. 

A very practical and simple method of preparing solution is as 
follows: After determining quantity required place tablets in a 
sterile test tube, add to this the proper amount of distilled water, 
which has been previously measured out into a graduated m'nimum 
glass. The test tube is then held over a bunsen flame, the tablets 
become dissolved, and the solution thoroughly sterilized. The test 
tube during the boiling of the solution should be rotated slowly to 
heat it uniformly in order to prevent breaking. The solution is then 
poured into hypodermic syringe which, of course, has been previously 
sterilized and ready for use. The practice of pouring the sterilized 
solution from the test tube into the glass and from there into syringe 
should not be encouraged, as it is an unnecessary step and invites 
sepsis. 

The Field of Operation. 

It is not always possible to sterilize the field of operation, and 
especially is this true within the oral cavity. Authorities differ as to 
the detail in preparing the gum tissue before injection. 

The area to be injected should be thoroughly dried and wiped off 
with H2 O., It is then considered wise to paint areas to be punc- 
tured by needle point with a weak solution of Tincture of Iodine. 
It is not sufficient to merely wipe surface with this, but it should be 
massaged into the gums with a pledget of cotton to ensure of "ts 
penetration beneath the epidermis. Some operators use a solution 
of colorless iodine and alypin. The addition of alypin is certainly 
an advantage, in that it desensitizes the epidermis and the puncture 
of the needle is unaccompanied by pain, but the effectiveness of 
colorless iodine as a germx'de is doubtful. 



OK \ I ff IM ! n 67 

Infiltration 

I Ik* kind of injection usually takes the name of the Iimu«^ 
which it is injected. A number of terms have therefore comr mt., 
use. such as "mucous anesthesia." "|>eriotteal anetlhesia." etc 
however, in injecting into gum tissue it is almost im|>oMible to ol»»-».i. 
mucous anesthesia without the solution |H^nelralmg the |>ctio«' 
and alveolus, resulting in anesthesia of the three, fhe %«Tilrr favor* 
the term "infiltration " I his. I believe, will no< l>e as confu*- f\ 

more descriptive of the result. For cxtroition it is » 

to insert the needle into healthy gum tissue al>out midwav • 

the gingivus and region of the a|>ex of the rooCs All air is ex|»«-||e<| 
from the syringe, which is held in the right hand, with secorid «nd 
third fingers of the left hand the lips are held apart, and ihr |»*>..:l 
of syringe is gently guided into place by thumb. \}\e onhce ol tK** 
needle should always open toward the bony procrst. As the ncrdJ^ 
is gradually forced through tissues the fluid is ex|>rlled Ilie fluid 
may become encysted and a "bleb" formed Ilie needle should thru 
be forced deeper or partially withdrawn, its d- • »■ -i chanr"' *~d 
<-mbedded into tissues which will absorb the i more % 

I lie periosteum is soon reached into which the nrrdle may he w 
scrted. and considerable of the fluid forced under pressure iKioufh 
process. I he sense of touch should be de\elo|>ed to do this itrofXTl) 
without breaking the needle. Should such an accid'-"' .*...' 'H^ 
needle should be inmiediately removed Vl'here the .» v -^ 

place slowly, and the pressure is constant, one may think that the 
aperture of the needle has become clogged, but a clowr ob«rr\atioci 
shows that the solution is slowly penetrating the aUeolus Il>e 
lewer needle punctures, consistent with gtK>d anesthesia, the l>ettrt 
To do this the needle may be a'most entirely withdrawn, the J 
lion changed .ind again inserted Occasionallv a 
injection is sufh( lent for one upper incisor If nef\e 
at hand it is .uKantageous to use combination t>f 
infiltration .ineslhesia. lor example, one lingual ir. ^ 

posterior palatine canal will suthce for the lingual rods 
second and third molars: for the buccal surface three «e|taralr 
tions m.»y be made into the gum tissue, or one ii ' 
of the luberi)s:ly .iboul owe hall inch aUixe thr „ 
the first and second mt>lai teeth I' or ordinary in n two 

lions over each tooth, one buccal or labial and one 
sufficient. 

\X'here a long neetlle is used, it may be t ! aim « 

osei the region of several teeth Where the , x» i« ?' 

dense, as in the regu>n of the lower molars, it is i 
greater length of lime to oI)lain anesthesia It is a«' to w«< 

from eight to ten minutes in difhcull case* in «>filef ? 
good anesthesia Pus. of cnirse. \Anc^ as lo |>ci 



i « » ■■• «i r 



68 ORAL HEALTH 

solution, and the rapidity of absorption. During this period agree- 
able conversation should be encouraged with patient to mininnize 
fears of the coming operation. 

For the removal of pulps it is necessary to inject as close 
as possible to apex. Anocain has proven very efficacious for 
the removal of pulps, and also as an obtundunt in preparing sensitive 
cavities. It is always desirable to use a 2% solution for this purpose. 
For extraction I have used in all cases a 1 % solution. In so doing 
I have had to add twice the amount of water that is used for a 2fo 
solution. It was then necessary to add additional sodium chloride 
to re-establish the normal saline solution. When the manufacturers 
learn that we have clinically proven the efficiency of a 1 % solution, 
a tablet no doubt will soon be ready for that purpose, and eliminate 
the necessity of adding more sodium chloride as mentioned above. 

Submitting anocain to the test for qualities previously mentioned 
for a local anesthetic, I would say that it measures up to the stand- 
ard to a very high degree. It is not irritating when injected into 
tissues; splendid anesthesia is produced; and in over one hundred 
cases in which I superintended its administration for extraction, each 
case being carefully recorded, as nearly as I was able to ascertam 
no after soreness nor tissue lesions have resulted. In only four cases 
had I any symptoms whatever. In two cases these were not of a 
serious nature, and were chiefly due to fear and nervousness. In the 
ether two cases the drug certainly produced systemic disturbances. 
The four cases were as follows: 

Case A. — Mrs. J., age 42, 150 minimums of 1% solution were 
injected; patient complained of nausea, but soon recovered after 
having been taken into the rest-room and allowed to recline on the 
couch for a short time. It is quite possible in this case that the 
operator who injected the solution allowed a little to escape mto the 
moi!th and the patient swallowed a small amount. The inconveni- 
ence caused in this case was so slight that it was scarcely v/orth 
recording, yet it is sufficient to show that the very closest observance 
was given to each patient and each case recorded. 

Case B. — Mr. P., age 42, patient of a very nervous temperament 
and undoubtedly susceptible. A small amount, 30 minimums, of a 
i % solution, was injected to remove a single tooth. Pulse became 
more rapid and patient lapsed into a slight narcotic slumber, mean- 
while perspir-ng slightly. For a moment he might have been uncon- 
scious, but soon he was able to keep up conversation. A few 
minutes later he gave a slight start as if he had been asleep, and he 
expressed his pleasure at having had a "beautiful dream. 

Case C. — This is a case where local anesthesia undoubtedly was 
centra indicated. Th's woman had a leaking valve of the heart, and 
the strictest care was taken of her at home. She avoided any exces- 
sive exercise, and never was left alone. Family physician refused 



OK A I. HP. All M trf 

to give her a general anesthetic. It wai neceuary to remove h\c 
roots. About 20 minirnums of a I' - solution were injected lnmie<ii- 
atrly patient roniplainrd of di//mrss and threatened lo « 
Smelling salts were given her. a dram of aromatic sptriU ol amroocua 
in half a glass of water were given her to drink. She fell murh 
better, and the administration and extraction of three teeth were then 
completed without any further inconvenience Ilie next day the 
returned and noxoc.un was used for the other two roots. She feh 
the same systemic di.sturl)ances. but not so marked. On r'^""""i{ 
home on this occasion, however, she was confined to her b«^ j 

few days. 

Case D. I his was an elderly woman, somewhat iiKlined to be 
melancholy, who became especially so after in - foliilion She 

began to tremble and weep, apologi/mg in ti. ...: antime for her 
actions. She could not understand it; she felt no \ukin, but kept 
excusing herself, and said that she had been l>ereaved a few months 
previously in the death of her husband. 



Impressions of the Twcnt) -third Annual Mreling of 
American Institute of Dental 1 rachrrs. 



Ihoma^s Cowling. D.DS.. Toronto. 



A\ \ 1 ION'S literature indicates with great accuracy the 
nation's ideals and aspirations. Ai with a nation, so with 
lesser (oinnunnties and organizations If one were gnen Ih** 
task of selecting fiom the mass of dental journals. pa|»rf%. etc . . .*- 
Iished throughout the entire world, the essays that eml>ody the 
thought in modern dentistry, one would instinctively turn to the 
journals published by the dental profession of the L'niled Stale* of 
America. 

I hat Anuiuan dental literature hold^ the premier |«o»*lion is <hK 
to the fact that dentistry in the Un led Statet. by rea«on ol the 
devotion and skill of its leaders, has far sur|»as»r<J thai of an\ nthrr 
and of all other countries The task of following anit ' . 

(obtaining a place alongside the leader j* >'■'•-'-.' » v#.tv 

I ake up «iny of the representative .Ai '• 

in them you will find a mass of carefully selected « >t 

is of inestimable value lo the dental and. we d 

professi(Mi as well. Condition* ha\e chanp 
that dentists are now jiimI ng t^'c medual 

thing of dental problems. In reviewing these pubkalion* «> 
ama/ed at the wide range of lubjecls *elecled for d 
various contributors men wilh special training in theu aci-Aximr:v^ . 



70 ORAL HEALTH 

men capable of great accuracy and detail, both in experimentation 
and observation. Indeed, the impression is forced upon one that 
these men are truly masters in their particular fields of activity. 

Within the past month the twenty-third annual meeting of the 
American Institute of Dental Teachers was held at Minneapolis. 
Many of the editors of and contributors to the American dental 
journals were present at this convention. Some of them took part 
in the deliberations of this body, so it was possible to get a near view 
of "the big guns in action" and supplement or correct views already 
established through more or less intimacy with their publications. It 
is true, unfortunately so, that an author oftentimes holds our admira- 
tion by reason of the many excellencies of his writings, yet falls 
miserably short of our expectations when brought into more or less 
intimate touch with us in committee deliberations or platform work. 
This was not true of those who took part in the sessions of the con- 
vention at Minneapolis. One could not help being thrilled when 
listening to the addresses delivered by these the leaders of the pro- 
fession. The technically trained mind, the cultured mind, the scien- 
tific mind — all were represented. That dentistry, under the leader- 
ship of men of such mental and moral fibre, will, ere long, take a 
recognized place well up with the best of the learned professions — 
this is the fact that was thrust home upon all who had the privilege 
of listening to these speakers. 

The purpose of the convention was to arrange a four years' course 
of study for dental students. It might be stated in explanation that 
next year all recognized dental colleges in the United States will 
give a four years' course. Now many require a student to be in 
attendance only three years. Committees prepared reports on the 
various subjects of the proposed new curriculum. These reports 
dealt with the correlation of subjects, methods of presentation, 
approximate time allotted to each, etc. The impossibility of arrang- 
ing one curriculum for all colleges was early made apparent. Many 
dental colleges are situated near the parent university, and are thus 
able to arrange for the teaching of scientific subjects in the Univer- 
sity proper. Other schools may be departments of a university 
located at a distance, and so are deprived of teaching advantages 
from that source. Then, again, one school may be richly endowed, 
either by individuals or the State, while others may perforce have 
to be self-sustaining. The problem of arranging a curriculum, there- 
fore, was recognized as being local or individual in character. 

One difficulty, and this seemed to be common with all schools, 
was the admission of students whose preparatory education did not 
include studies in scientific subjects, such as physics and chemistry. 
If these students find their way to the schools of dentistry, under 
present conditions, they are placed en the same basis in the first year 
as those who have already received training in these subjects. 



OKAL HMAL I W 71 

Obviously, this is unfair T\\c consensus of ofnnion was ihal 6' 
cnWv^rf, oukIiI not to takr u|>on tfjrms^-lvrs work profM-rly beloci«tit« 
to ihr preparatory schools It was thought iKWMhIr to A|>|iro«ck thr 
high school authorities with the view of having thrm make ihr^ 
subjects compulsory for all students, whether or no< ihey conf*^ 
plated a |)rofessional career. In the dental department of the I . 
\ersity of the State of Minnesota it is now a rule lo refuse full adrnis 
sion lo a student who has not received training in chemtstry »t^f^ 
physics. If a student applies and has not had pre|>aralion in ( 
subjects, he is referred to these departments for mstruction. and 
having completed his studies in these branches he is then allotv-rd 
into the first year class. In effect, then, he is kept out for one v*-t 
1 he advantage of such a method is that all students of the first >• i 
are on the same basis as regards preliminary training, and the cUm 
|)roceeds. as a whole, with the regular curriculum of studies. 

Where the dental college is a department of a ur 
versily. a curriculum is sometimes arranged so that *uiii mjujc^h «* 
physics, chemistry, biology, technical drawing. I.nglish. hislolcHrr. 
bacteriology and metallurgy are given in the first and second yr 
Credits are allowed for all. or nearly all. of these subjects in the 
general university courses, so that if a student is deemed, at the end 
of the first or second years, unsuited for dentistry, he may l>e ff'-""^ 
lo some other course in the university, and will not have -^ i 

serious loss of lime through attendance in the department of dentistry 

In |>raclically all of the dental colleges visited by the I or onto 
dele^«»les it was found ih.il the heads of departments, or nearly all. 
were full lime men I hat is to say. the teachers spent all their t»mr 
in the school and did not attempt to carry on private firactKe as 
well III Nut h an arrangement there is an undoubted advanlaft^ 
More lime can be given to the students. es|>mallv th«He wht> v 
backward with their studies On the other hand there is da — ' 
a teacher, who is out of touch with actual condilitws of \ 
gelling away from the absolute essentials in dentistry. 

Many dental colleges have allied themselves cK' ilh thr 

medical departments of the university By this v%e mrai. J 
the first two years the students in dentistry and mr^ - tak- , - 
lically the same work It is claimed for this ^\ .it a nw^ 

complete uiulerstanding between dentists and ; »fu • bfOU«hi 

about because each sees the view|H)int of the other At 
University. Montreal, such an orran 
upon the introduction tif the ftnir yea. 
some such plan will be adopted in m«- 

authorities are op|>osed lo any such affihaluw because, as they da; - 
the dental student <\oct not gel ihal partKular car ♦*• 

Dentistry in C*reat nnlain i* hanth- > !. so it i- . ,.»,...,,. ».j ..•*o« 
of lis being ctMulucted under just .jndltioo* 



72 ORAL HEALTH 

In an editorial appearing in The Journal of the Allied Dental 
Societies, December, 1915, issue, the relation of dentistry to medicine 
and the adoption of the four-year course is commented upon in part 
as follows: "The dental specialty has taken its natural place as an 
essential part of general medicine, and not only our medical facul- 
ties, but our public men of financial power are aiding in bringing 
about the founding of suitable institutions of learning, whereby the 
dental graduate in times to come will be equipped adequately to 
care for the human body from his special viewpoint — modern den- 
tistry demands varied and positive capabilities. The practitioner 
should have the maximum of general medicinal knowledge, consistent 
with the special training necessary to make him a competent dentist. 
The dentist, while he should be a good physician, must have these 
added qualifications (i.e., digital skill, etc.), in order to practise his 
specialty. Therefore the question presses: What constitutes a 
curriculum which shall meet these varied needs within the four years 
prescribed for the regular medicinal course? 

It may be stated at once that the preliminary requirements should 
be those demanded of the medical matriculate, and that in total 
working time and academic credit the dental course should be the 
equivalent of the medical, as prescribed in our leading universities. 
The first two years would naturally be nearly parallel in the two 
courses, but some divergence will exist from the beginning. The 
dental student should k^ow from the first that he is to be a dentist. 

Among some of the striking innovations in the specimen curricula 
submitted to the convention was the inclusion of English as a first 
year subject in dentistry. This subject embraces description, narra- 
tion, exposition and argumentation. Time is allotted this subject 
throughout the entire first year. It was pointed out, by way of 
explanation, that in the United States the standard of admission into 
colleges was a varied one, it being possible to obtain entrance with 
only a very poor knowledge of the English language. Manifestly 
it increased the difficulty from the teacher's standpoint. How could 
a student receive instruction which was given in English, if such 
student did not understand English? For Canadian dental colleges 
this difficulty is not so marked. Mechanical drawing becomes a 
subject of the first year, so that students may become proficient in 
illustrating simple dental appliances, etc. Afterwards, when as a 
practising dentist, he is called upon to write an article for publica- 
tion, he is able to make suitable illustration, and so amplify his work. 

One of the outstanding features of the convention was the fact 
that unanimously the delegates agreed that the extra time secured by 
reason of extending the course one year, should be devoted to further 
consideration of subjects such as physics, chemistry, bacteriology, 
pathology, physiology, etc. Practically no added time was granted 
to purely operative departments. It was deemed advisable to urge 



OK A I HEALTH 73 

the high schools to rchcvc the college of »uch tubjrcU at l^nglith 
or thr cultural subjects, and leave to the dental college the duty of 
emphasizing the scientific subjects. Iliis might mean the etacting 
of a higher standard frcjm ihr high schools, but it would be worth 
while. I he inauguralK^n of the four-year course m all colleges m 
America marks the turn of the tide. Ilie future of dentistry it as- 
sured! i.ook at the adjustment of the new currKulum of studies' 
Observe the extra amount of time allotted to the study of bacteriology. 
physiology, chemistry and allird v irnlifir subjects. In some cases 
the amount of time gi\en under the old three year course for o{>eTati%e 
and prosthetic technique has actually been curtailed under thr 
estimated four-year course. Interpret this in any light whatsoever 
and the only conclusion to be arrived at is that the mechanical 
dentist of yesterday has to give place to the scientific dentist of to- 
morrow "Prevention inslrad of cure" this \*> thr nrw motto fa* 
dentists. 



Address Delivered lo Toronto Denlisis I \ .M.i -t 
Clayton, Acting Cliiet Denial Ofiicer. 
Canadian Army Dental Corps. 



ON Saturday afternoon. Jaiui.iiv J*>. I^)l(). the drntisls of 
I oronlo gathered in the Assembly I lall of the Denial C ollege, 
I oronto. upon the invitation of C aptain VI G. 1 relfocd. 
C.A.D.C, O.C, No. 2 Division, to meet and hear .Major Clayton, 
who recently returned from six months' overseas servKe. 

Dr. K. Gordon McLean made an ideal chairman and the college 
orchestra was much appreciated by tlu>se present 

Major Clayton paid tribute to the sterling qualities of the Cana- 
dian soldiers at the front, saying that no matter lo whal branch of 
the service they belonged, they could not be pul in that class called 
cowards. Canadi«ins were m.idr of the fabric that sees a ihmg 
through lo the end. Major C layton e.\prev%ed the oftinton ihal po»« 
sibly the C AD C. had matle mistakes, just as every branch of ihe 
service and every nation had made mistakes. And yet coi a ihe 

short time of its existence it hat! ' rt\ wondeilul g<wd 

Dental clinics havr been eslabhshrti i .. -"rfalion fr«^^ \*^m 

couver to Maiif.ix. lo (ireecr and bai k to i ^ >d again. g 

as well services to Canadian triKi|>s in France and Brlnuim 

A passing tribute was paid to the many dental * in Canada 

for the prepaialorv work that was .\' < ' » *\^f, foyfid- 

ing of ihr Dental (^Hps. A \ery gi.i, ..- - - ^^-»' •: ^""n <^ the 

eslablishnienl of dental cIinKs o\erseas Hiese are Wi operalKMl al 
.Shornclitfr. where there are six chairs, and a central denial la* 



74 ORAL HEALTH 

tory at St. Martin's Plain, manned by upwards of twenty men. 
Forty to fifty dentures are finished per day, and the dental corps is 
at times overwhelmed by the hundreds of patients presenting them- 
pelves each day. The same conditions prevail at a clinic established 
at Havre, France. The dental surgeons work hard and find their 
reward in the gratitude of the Canadian soldiers, who sincerely 
appreciate the attention they receive. 

Similar clinics are in operation on Sir John Moore's plain, Napier, 
Risborough, Ross and Somerset barracks, and all are overwhelmed 
with work. In France the dental members of the Canadian Army 
Medical Corps were absorbed by the dental unit, but the work in this 
section has been entirely inadequate, as the C.A.M.C. deemed it 
unnecessary to have more than one dental surgeon attached to each 
field ambulance. This has necessitated the invaliding of many sol- 
diers back to the various bases, with consequent heavy loss of time, 
to have their dental work attended to. Vast numbers of soldiers 
have, during the progress of the war, been incapacitated through 
dental conditions, and this of course represents tremendous economic 
loss. 

In the absorption of the A.M.C. dentists by the C.A.D.C. an 
important gain to the A.M.C. officers is effected, in that they at once 
received substantive rank where before only honorary rank had been 
received (for, in some cases, as much as nine years' service). The 
formation of the C.A.D.C. was responsible for dental officers receiv- 
ing substantive rank, whose services, however much needed and 
appreciated, only received honorary recognition under the old regime. 

Major Clayton asked why the Dental Corps should not have 
complete access to the Red Cross stores, and made a strong appeal 
for the loyal and active support of the entire dental profession. 

The speaker proved himself an entertaining and forceful speaker, 
and was most eloquent in his vivid description of his trip across and 
the dangers encountered in the "submarine zone." Major Clayton's 
address was an inspiration to those present, and awakened a new 
and more intelligent interest in the affairs of the Canadian Army 
Dental Corps. 

Tribute to Sir Sam Hughes. 

During the progress of the meeting both Major Clayton and the 
chairman paid tribute to the Honorable the Minister of Militia and 
Defence, Major-General Sam Hughes, K.C.B., for his services in 
connection with the organization of the Canadian Army Dental 
Corps. Sir Sam Hughes is the one to whom credit belongs for the 
organization of the corps, and continues to take the keenest interest 
in its welfare and continued development. The dental profession in 
Canada owe much to Sir Sam for placing the dental services in the 
militia upon a basis which will make for the greatest efficiency. 

Captain Trelford gave an interesting report of the dental work 



ORAL HEALI H 75 

accorn|)lisl»rd at Kxhihilion ("amp, Toronto, and paid Inbutr !o \Ke 
high rfficK-ncy of ihr chnic. which had been under ihc dixcctloo M 
Captain Hume until the time of his transfer to Salonika. 

Dr. Wallace Scccombc gave a re|>oft of the Canadtan Atmy 
Drfital fund and thr nirrtmg adjourned follo\%ing a hearty reiMlef- 
ing of the National .Anthem. 



Great Need for Reading Mallf r at the Front. 
\\iH\ Drntist May Hklp 



CAIM.AIN (HAS. A. COKKIGAN. Dental Surgeon. %r|io 
went to th«- front with the first Canadian Contingent, attached 
to the Army Service Corps, and now stationed m Randen. 
has written members of the dental profession suggesting the iweMifig 
need for reading matter m the trenches Maga/ines. such as aie 
usually found in a dental reception room, or in fact any of the 
regular monthlies, are appreciated by the soldiers In many cams, 
''something to read" is more in demand than "smoket," and n hr- 
(|U<-ntly less available. 

M<iny C anaduins at home regret they are unable to be ol grcftlcf 
service in the struggle, but who is there t)ut can rememt>er to 9niid 
over a package of maga/ines each month) Ilus n a small requcil. 
but its fulfilment is most im|)ortant Keading mailer is rssenlial lo 
the comfort of the soldu-r. and is (|uite neces.sary if *"■ ■* '" f"-%i"»-»«f' 
his health and general efficiency 

Send a package off now and make an entry in your a|>f>oiiiimeiil 
book each month that the matter may not esca|)e your attenlioa •• 
the futur«v Dr Corrigan's work is of such a ' ter as • — !»»- 

him to not only appreciate the demand, but ;. •- t \tomil 
that the maga/ines you send find iheir way lo the place where thr» 
an* m«)st nrcd«-(l 

Address : 

Cap IAIN Cha5 A Corrk^an. 

No. 3 CompAny. 

Divisional I ram. 

First Canadian Division. 

Canadian Kxpedilionarv finir. 

France 

The pancl-poil rate ol poiiagc prevails Inr ' ^"d ^-n^^ 

odicals sent direct from Canada lo I* ranee, m- 
tents \u mailinw. the |H>stmaster will affix a .^ 
bv the MMidei. that the parcel contains magazines only 



Splint for Fractured Mandible.' 

William Herndon PeI^D.D.S.. Norfolk, Va. 

.OTH.NG o...n. .^.^^^^^ 
|\ never ^eeii one liKe u, n ■» j 

application. ^ ■ absolutely necessary. 

A proper plaster impression ot the mou ^ 

Saw model of the mandible ^'^^''l'^\°'l2^'' ^^ J case here 
together in their proper occlusion and hx ^^"^^j ' ,. j^^ j^fj six- 
llibited, fracture is between l^f'^-P'^ ^^"t^u 7-' -^^^^^ ^"^ 
^^^rK'"e^^e n:?beftroth'-s*chosen, which is the second 
^utr AteHa^d was .-s-^d tojit ^ ha^.^t^^^^ 
threaded portion to the buccal side °f '°;* •,^'" J^\ „'; the threaded 
band for the first n.o,ar of ^-^-^ ^ ' pted\ position o„ 

Tmod'el tie a^ece o?.old P'™ ^ ^^ T^S^^ 
^2^:^^t^- °t" is t" Soldered I the bands 

in position. 




Now take two small pieces of tube and fit to the dreaded position 
of band on the buccal side, having tubes so tha they ^^^^ ^^^ 
Take niece of 20 gauge wire of material that the temper 
removed gold wire'could be used) bend as shown in Fig^ 3 then 
fi.T iTKi.l .nrface of teeth and solder to tube at each end, havmg 

. ■ • cf t T^pntal Society Richmond, Va.. November, 1015. 

*Table (Minic, A^irsmm ^State Dental hocieiv , iv 




model, place the labial arch on to *ec that it is in riirhi |>o«ition. N 
we are ready to install appliance on patient Rrmove the Ubi*! 
arch and place the lingual arch in (KMition. working ooc band m 
place at a time and lightening same. When the^r banck are m 
position and nuts tightened the jaws will be forced in their proper 
(>osition with a little help of your fingers at the broken parts. Havmg 
the jaws properly occluded, slip the labial arch on and tifhicii 
screws; this will hold the jaws absolutely rigid. 




To overcome any possible change in the two 
small wire ligature (about No 28 to W)). ruiim"'. 
teeth from one arch to the other, and when nece^^aiN 
put arouiul any individual loolh when drrmed a.; to 

force anchorage 

This appliance is also applicable to fr.ntvirrd tn.^\ilU. and ' 
IS one great advantage in this splint it dix-* aw.i^ - " the nr* 
(^f wr.uing a bandage 



Chicago Dental Society's Fifty-second Annual Meeting. 



W. B. Amy, D.D.S., Toronto. 



ON January the twenty-eighth and twenty-ninth, the Chicago 
Dental Society held its annual clinic at the La Salle Hotel. 
The chronicling of this event may not, at first glance, 
appear to be of any interest to the Ontario dentist, as the great 
majority of them apparently do not recognize the importance of just 
such gatherings. But those who know spare neither time nor expense 
to be on hand when the Chicago Dental Society holds its annual 
meeting. 

The importance of these dental conventions consists not only in 
the knowledge we obtain professionally, but in the broader outlook 
we get on life, through intercourse with men who have seen visions 
we have not seen, and who have accomplished great things for 
humanity. Thus benefited, we return home with a fresh grip on 
ourselves, a stronger belief in the needs of our profession, and better 
citizens in every sense of the term. 

The Chicago Dental Society, generous in all of its undertakings, 
uses the greater part of two floors of the La Salle Hotel for its 
meetings. The exhibitors occupy one very large room and numerous 
smaller ones for their varied displays. The clinics are given in the 
large banqueting hall of the hotel, with overflow clinics in some of 
the nearby rooms. 

The first day was wholly given over to surgical clinics of different 
kinds. Dr. Thos. L. Gilmer gave a surgical clinic at the North 
Western University Dental School, removing cysts, etc. ; Dr. T. W. 
Brophy a "Cleft Palate Clinic" at St. Joseph's Hospital; Dr. 
W. H. G. Logan, a surgical clinic and special demonstration of 
conductive anaesthesia with novocain, at the Willard Hospital. 

Dr. Roy G. Pearce gave a special clinic demonstrating the effect 
of nitrous oxide anaesthesia, asphyxia, hemorrhage, pain, and shock 
on the circulation, at the University of Illmois, and Dr. Louis Schultz 
followed Dr. Peace at the same college, with a clinic showing the 
technique and application of novocain in dental and surgical pro- 
cedures. 

In the evening seven or eight hundred dentists gathered in the 
banqueting hall of the La Salle Hotel to listen to Dr. Edward C. 
Kirk give an exceedingly scholarly and interesting paper on "The 
Problem of Dental Education in the Light of Public Demand." 

Saturday, the twenty-ninth, was wholly taken up with table 
clinics, of which there were about seventy-two. 

We could not help but admire the thoroughness with which all 
the details had been worked out, and the enthusiasm evinced by 
those in charge. Nothing seems too great a sacrifice for these men 
to make, and it is to men such as these that dentistry owes a debt 
that only posterity can pay. 



^ 



' T/IE COMPEXDirM 

I hi- l)«-)Mrliiir|ll !•• F^lilrii |i% 
III«»M\- (MVIIIX;. DD.S. r»r..nlo 

A .SVN()|»SIS OF CI HKKM I.I IKK Ml KK RKL\T1N«. 
Tf) THK SCIKNCF. AM) PKACTKiK OK DUVHSTRV 



-rz 



PYORRHhJV ALVF0LARI5. 

AI<I\.SLMI, of our knowledge of ihis baffling dmtal 
forces one to the conclusion that, in spite of the fact that it ii 
occupying the tliought and attention of more research wofkcft 
ihan any other branch of dental pathology, yet we ha\r proyrr^^ed 
but little in essentials A brief synopsis of the accepted facts rcUkling 
to the disease would appear to be as follows: 

Patholog}}. I albol .md Noyes describe the pathology ol the 
disease as a traumatism of the circular ligament resulting in a firo- 
^ressive chronic periodontitis combined with destruction of the OMcouf 
alveolus. I he soft tissue is altered into granulating tissue with more 
or less f)us formation. Systemically. a certain predis|)osilion srrm!^ 
to be necessary for the development of the disease, and in m«Ht 
cases local deposits of calculus present with loo^iening of the notmal 
attachment of the gums to the teeth 

/Jio/o^'V. In our present state of knowledge, the rfiolofor would 
appear to be somewhat complex, since we cannot |>oinl definitrlv to 
any one tiefinite causative agent. I artar formation. I>acterta. r 
elusion, trismus, nervous grinding of the teeth. Ir.» u 

the commoner h>cal c.iuses. whilst riiif/idoritt/ Jts: ^i 

to chronic rheum.itism. liiabetes. auto-intoMcation. chltjcmi*. •\ a. 

pregnancy, etc.; infections, such as tuberculosis, pneumonia. |»m- 
carditis, syphilis; toxic mcdicimil agents. sikH a> metcurv. lead. 
iodine, etc ; these seem to bung about a condition ol reduced ir%t9t 
ance that wouUI systemu.illv predis|x»e to pyocfhca 

S\jniptonis. I. i .o«)seness of teeth; 2. rrdn«». »wcllin« and kwMH- 
ing. or shrinking of the gingival; 3. secretions; 4. f«' 
kels and granulations; 4. dull sound on |>ercuMion^ J, r 
and inoNabihtv of teeth; (). de|H»sititMi of lartAr; /. f--' 
hstula with fetid breath from discharge; 8. swelling • < 

glands; 0. pulp reactions; 10. gradual advance ol the ditrase Mnd 
lendencv to recurrence 



80 ORAL HEALTH 

Therapy. — Local removal of all calculus deposits and polishing 
of the root surfaces is an absolute essential to any form of medicinal 
treatment. This may be accomplished by mechanical means, the 
operator using the form of scaler which in his hands has given best 
clinical results, and he may augment this by the use of some of the 
chemical agents at his disposal, such as formic, aromatic sulphuric, 
trichloracetic, hydrochloric, lactic or nitric acids; or ammonium 
fiuorid to decalcify the tartar and assist the work of instrumentation. 
Masticatory stress must be made uniform, splints applied to very 
loose teeth, and those teeth removed where the prognosis is unfavor- 
able. The pockets should be cleansed with H2 02 or hot glyco- 
thymoline; preparations of iodine, chlorophenol, or zinc chloride 
may be applied to reduce the inflammation, and these are assisted 
by digital or vibratory massage and the use of the high frequency 
current. The systemic treatment would appear to indicate close 
attention to the alimentary functions, the cleansing of the intestinal 
tract by the use of salines, etc. Deep muscular injections of 4-5 gr. 
of succinimid of mercury, as suggested by Dr. B. L. Wright, have 
given wonderful results. When, upon the examination of pus from 
the pockets, endamoebae buccalis are found to be present, hypo- 
dermic injections of emetine hydro chloride may be of assistance. 
The use of vaccines for combatting the micro organisms is question- 
able, and to quote Dr. Riethmuller: "He who wishes to treat 
pyorrhea successfully had better become a skillful, deft operator 
first instead of pinning his faith to the hypodermic syringe." 

Rapid Treatment of Pyorrhea and of Sensitive Cavities 

BY Electricity. 

In the CommontDealth Dental Review, December, 1915, Dr. R. 
Morse Withycombe takes up the question of Cataphoresis as applied 
to dentistry. The failure of this method in desensitizing cavities is 
due to the fact that the electrode must be held in the cavity for about 
fifteen minutes, a procedure which is "a sore trial to the operator 
and most unpleasant for the patient." A second cause of failure is, 
in the author's opinion, the practise of using too small an electrode. 
In the method of treatment outHned by Dr. Withycombe, a rheostat 
is used and is particularly described as follows: "Prepare a piece 
of tough wood, nine inches long by one-eighth of an inch in diameter, 
sand-paper to a smooth round surface; allow this wooden rod to 
stand; when not in use, in a test tube containing a small quantity of 
glycerine and salt. Procure a solid carbon cylinder about one inch 
in diameter, and saw off two pieces each an inch long. Now bore 
£j hole horizontally in both to permit of the easy passage of the. 
wooden rod through. Next bore transverse holes in each for the 
purpose of receiving the two terminals of broken circuit. Make a 
plaster of Paris stand with two supporting arms for the wooden rod 
to be suspended between, which may be suitably enamelled. We 



ORAL N KALI H 61 

now have ihc wooden rod saturated at one end. two carbom. and 

a planter stand, wliicli comhinrd make an rxcellrnl rhroitJil. WKm 
about to opcratr. I rrmoM- the vvoodrn rod from the test tube 4Uid 
pass it through both carbons and suspend the whole on its iland, aikL 
placing the terminals of broken circuit in transverse holes, slide one 
carbon to one end of the rod and the other to the other; the Ofir oci 
thr dry end is the one to be adjusted, the current bdnf iorr ' 

with Its passage along the rod. In this way there is no sudden ..•- ^ 
as with a cell collector, and no metal or screws being us«d. we reduce 
to a minimum the chance of an accidental breakage of the cvcuil. 
or clogging with verdigris " M'hen treating several teeth tiroul- 
faneously by this method a bunch of fine insulated wires branching 
from a main supply wire is used. A de^ensiti/ing |>aste is pfep«red 
by mixing fresh cocaine with a drop of normal saline solution. This 
paste is incorporated into a ball, formed by rolling together a |)cece 
of gau/e composed of very hne wire and silk Iliis wire and silk 
gau/e enclosing the cocaine paste is cut into |>ellels and placed in 
the cavity to be desensiti/ed. A wire terminal is connected to the 
pelht aiui till- cavity sealed up with a preparation of gulta|>ercha 
and wax. I he wire gau/e is used because of the innumerable edgrs 
of terminals from which the current may pour " Ilie indiffrrrnt or 
negative electrode is now placed m position and the current switched 
on to a strictly comfortable amount, the most sensitive cavity becom- 
ing the index or least common denominator of the whole Ilie cw- 
rent is agreeably raised during the administration until at length all 
sensation of it to the patient disappears." 

In treating pyorrhea, the author considers that two farms ol elcc 
Iricity at least are necessary, namely. GaUanism and f'aradisin! thr 
first used for ionisation an effectual means of destroying pyofrmc 
micro-organisms; the latter being used to stimulate ner^e action 
The terhni()ue in this case is described by the author "I ci< 
tin foil into a number of strips, such as we pre|»are in gold 
banded crown work, and have sewn around them a thin la\rt nl 
cottonoid. after which they are |>erforrtted freely with a needle, my 
object being to surround every neck and r<x>t with a cotnlnned nrf» 
forated mei.d and («?tt«)noid collar, which mav In- saluratr-J *-»*^ * 
zinc solution I pass them well down inl«» the |»»xkrt* - 
secure them in position with a clamp I then link up thr « 
with wire and protect the area to l>e treated from saliva with 
rolls I now place a band of combinr<l tin foil aiuI ».il!.>n.Md • 
is saturated in normal saline solution. af«nind «♦"- u-tim*. %»'- i. - 
between them and the cotton lolU I hrn ' thw « his 

band with the faradic current, adjust the indifferent r|r, ! ,ir^. and 
we are now prepared to give two form* of treatment •imultanr.^MK 
:onisation and faradisation " 



82 ORAL HEALTH 

Cobalt as a Substitute For Arsenic in Devitalization of 

THE Pulp. 

An original communication by an unknown author appears in the 
British Journal oj Denial Science, January, 1916. Recognizing the 
danger of necrosis, etc., attending the use of arsenic in the tooth pulp, 
the author suggests the substitution of a salt of cobalt. This salt is 
mixed with oil of cloves and used precisely as arsenic is used. "Th's 
agent, if applied properly, usually takes two days to act, but its 
application is, as a rule, unattended by the two hours of pain which 
is always to be anticipated in the case of arsenic.*' The author 
admits that the action of cobalt may possibly be due to the presence 
in the salt of minute quantities of arsenic. In further commendation 
of this salt as a devitalizing agent the author says: "This cobalt 
dressing can be left in the tooth without any danger of it travelling 
through the apices, and this is so even in the case of children; how- 
ever, it is inadvisable to leave the cobalt in for longer than a week." 
In view of the above advantages the use of cobalt is suggested in 
those cases where there is a probability of the patient not returning 
for treatment at the proper time. If arsenic were left in the tooth 
a condition of soreness, etc., would obtain, making further operative 
methods very difficult. Cobalt would be indicated under such con- 
ditions. Another great advantage of cobalt over arsenic is when an 
exposure of the pulp is obtained. "Should a cavity be very sensitive, 
a little novocain swabbed round will probably enable the operator 
to obtain the exposure, and should there not be time to permit the 
completion of the operation, then cobalt may be applied. When 
this procedure is adopted, the pulp at the second appointment should 
be dead, and it is quite exceptional for a second application of the 
cobalt to be made. A bristle placed in the canal in the ordinary 
way will remove the pulp in one piece — in fact, it is difficult to say 
if there is any greater lack of facility in removing it either under the 
mfluence of cocaine or of a cobalt dressing. Should the cobalt not 
have taken effect as desired, cocaine may be then used quite satis- 
factorily, but after the use of arsenic cocaine proves to be of no 
value." 

Cases of Occupational Influences Upon the Teeth. 

A very interesting account of observations of occupational influ- 
ence upon the teeth is given by Christopher C. Beling, M.D., 
Newark, N.J., in the December, 1915, issue of Dental Cosmos. 
He finds that "workers exposed to the effects of mercury and arsenic 
are more prone to suffer from putrefactions of the gums, which induce 
pyorrhea and oral sepsis." Regarding the effects of copper, he 
instances a case of a man fifty-eight years of age, who had been a 
worker in copper for twenty-nine years. "He was suffering from 
mental depression and neurasthenic symptoms. There was a heavy 
lustrous deposit of a greenish brown color on his teeth, but no evi- 



OK A I H I. A LI H 83 

dcnce of scf)sis. caries, or recession of the gum* He had never ukrn 
any care of his tcrth. In his case it is reasonable to conclude ' 
the copper sails had a pro|)hylaclic influence against the occurrencr 
of carirs and oral srpsis. I h\s aUo rmpha^i/r^ the fact. "• " 
ni/rd by llu* dental profession, that copjirr amalgam has a ,r^...^.^l 
.»nd preservative action in the prevention of dental canes." 

I urnifi^ to the rffr( ts of mercury, a striking contrast ts made 
1 he author speaks of a strong, well-built man. forty nine years oi 
age. who. having worked as a hatter for twenty-two yrar«. had long 
been exposed to the influence of mercury. "He had always been 
well, except for occasional gastro-intestinal disturbances Durinf 
the past four or five months he had complained of pain in his |oinls 
and neuralgic pains diffused all over his body For about ' 
months the right shoulder was cjuite painful and stiff On the ij.»» 
of examination he complained of severe, paroxysmal |>ain in the 
head, so intense that he thought he would lose his mind. Hi* *k"i 
was cold. pale, and bathed in a profuse |)erspiration Ilie tongue 
was heavily coated, the flow of saliva increased, the gums were 
swollen, tender, covered with pus and bleeding readilv P%nrT|v4 
was marked, caries slight." 

K(K)i Canal Iilling — Two MrTMoa^. 

Dr. 11 C Werts. in Dental Sunimar}), January. 1^16. gnes a 
brief outline of two methods for filling root canals. 

"firs/ Method. I)r Callahan's methtKl Pi^MiUr 12 gr resin 
(violin bow) in two drams of chloroform i his |>fe|>arAtion is 

< arried to the orifice of the canal with the dressing pliers, and |Him(>rd 
It) the apex, followed by gutla percha |M>inls to hll the canal 

"Sccorul Method, by Dr. lUickley: It has l>een found that air 
cannot be displaced by a solid or a semi solid. It is theiefote no -• 
sary to displace the air in a r(M)t canal with a lic|uid. using a squaf 
broach to pumj) the IkjuuI to the apex, as a round lai»*-»wiv? bf.v.nS 
entering a can.il of the s.ime sha|>e acts at a valve. \ 
air from escaping. The scjuare broach comes in contact with the 
canal along its four angles, letting the air esca|>e and the lu|uid lal*^ 
its |)la(e l.ucalyptol compound is the lujuid Ilns li()uid i« d>» 
phiced by eucapeK l> » « ompouml. » srmi >..hd. folKnsrtl b\ cutu 
percha points " 




D 



MVLTUM IN PARVO 

This Department is Edited by 
C. A. KENNEDY, D.D.S., 2 College Street, Toronto 

HELPFUL PRACTICAL SUGGESTIONS FOR PUBLICATION, SENT IN BY MEM- 
BERS OF THE PROFESSION. WILL BE APPRECIATED BY THIS DEPARTMENT 



D 



D 



D 



Varnish For Silicate Cement Fillings. — A good varnish 
for protecting silicate cement fillings against moisture may be made 
by dissolving sticky wax in ether. — R. S. Bo])s, Commonwealth 
Dental Review. 

To Compensate For Shrinkage in a Large Gold Inlay. — 
Where a cast gold inlay is to be made for a cavity involving the 
mesial, occlusal and distal surfaces of a biscuspid or molar, if there 
is any shrinkage the inlay w^ill invariably show a defective line at the 
gingival margins. To overcome this, the gingival margins of the 
cavity should be quite freely beveled so that the inlay will cover them 
with a lap joint instead of a butt joint. Even if there is a slight 
shrinkage, the thin lap of gold can be burnished down to the cavity 
margin, so that when cemented the inlay will perfectly seal the cavity. 
— Dental Review. 

Obtaining Correct Bite. — It is often difficult to persuade a 
patient who persistently pushes his lower jaw forward to bite in 
something approaching the proper position. We have all heard and 
tried many tips concerning this, but if others fail, the following pro- 
cedure will often be successful. Ask the patient to sit up in the chair 
well away from the head-rest, to throw his head back as far as 
possible, looking up to the ceiling, and to close his mouth in the most 
comfortable position he can. If he thrusts his mandible forward now, 
it will only be by a determined effort to do so. — E. Holman, British 
Dental Journal. 

Finishing Synthetic Porcelain Fillings. — The instruments 
used in reducing the size of a synthetic porcelain filling should be the 
same as those used for reducing the bulk of a gold filling. The manu- 
facturers advise not to use any steel instruments in the finishing of 
these fillings. They only suffer from a nightmare, as we have either 
inserted or supervised the insertion of hundreds, perhaps thousands, 
of these fillings, and have yet to see the first synthetic porcelain dis- 
color when care was used during the mixing process. — C. Davis^ 
Western Dental Journal. 



ORAL HKAL I M 55 

Sfjvling MuDrc amknts in Teeth- A pledget of cotton rolled 

in thick cfiloro-pcrcha is superior to cotton and tandarac for tealing 
medicaments in cavities. Dental Digest. 

BuKN.s From A( ids. If you get car(>olK acid on any furfacr 
where it is not wanted, apply absolute alcohol at once. If hydro- 
fluoric acid, apply a strong solution of bicarbonate of toda. Ne^er 
use these acids without having readily at hand some agent to ftoft 
their action inmiediat<"ly in case of accidrnt Dmtiil Rrvirw 

Xvi.oi For Di.ssoi.\tNc; Gi'TTA-F^k< ha ( om.s i kom K'- 
I l.( ILV I ILLLU K(XJI-CaNAI..s. Dt /.lerold. of Minneaj>oU*. .... 
suggested the use of xylol for dissolving out gutta-|>ercha cone* m 
imperfectly filled root-canals. It seems to work admirably. Denial 
RcvicUK 

Fkacturk. of the Ma.ndible in Children In young chil- 
dren it is sometimes impossible to make a diagnosis immediately after 
the rnaiHlihIr has br<*n fractured, except by the use of skiagraphy or 
by the aid of an anaesthetic ; nor is it strictly necessary so to ck) jlie 
parts are so much inflamed and swollen with effused blood that, even 
if a fracture were detected, it would be harmful as wejj as |>ainful to 
apply |)ressure in any form over the swollen tissues. After a few 
days most of the blood and exuded lymph will have become absorbeJ. 
the inflammation will h<i\e subsided, so that the mouth can be opened 
to a greater extent, and a more thorough examination made with a 
view to diagnosis and subse(|uent treatment Kven if wiring of the 
bony fragments be c(Mitemplated. this operation is rendered far 
easier and less risk of sepsis is incurred if it be delayed until aI»«'W!». 
tion of some of the inflammatory exudation has taken pla> <- \ i 
tures in children can usually be treated satisfrtctocily with metal, 
gutta-percha, or poroplastic splints molded to the outside of '" 

In adults, if there be but little tendency to r'- • ' v • «i| ;,„ i,.,^ 

meiits. lilt s.une methods will suJfice f- ( i MonlMt. 

Thi. I LAI I OWf R I\W ']l\r ilenli^l wh«> has not had the r\ 
penence in his own mouth t)f that problem of the mouth, the Rat 
lower jaw. as I have had for twebe years, has not the least coocefv 
tion of wh.il tin patient has to undergo m becoming used to a denture 
on such a jaw I he result has been that I ha\e I ^ 

which I could not otherwise have learned. L,c i f<»MVfu. x ; .i^o. 
///. (Dental Kcvicw). 

r.MIR(;EN(Y F^IPAIR Ol KlHIUR lU I B OF CHIP '' 
The break in the rubber bulb of .1 chip blower may l>e ♦ h 

.\ thin laver of cotton, which 1* pamletl with collodion a d 

to drv This repair will last until a new bulb can be secured 
y. S. Walker (Western Dental Journal). 




CANADIAN ARMY DENTAL CORPS 
Overseas'"' 



Complimentary copies 
of Oral Health will be 
sent during the pro- 
gress of the war to all 
Dental Graduates on 
active service whose 
army address is 
known. 



Lt.-Col. J. A. Ai-nistion,y. 
Major O. K. Gibson. 
Major A. A. Smith. 
Capt. J. W. Bell. 
Capt. C. Blown. 
Capt. J. F. Blair. 
Capt. G. N. Briggs. 
Capt. AV. J. Bentle.v. 
Capt. G. S. Cameton. 
Capt. O. A. Elliott. 
Capt. E. A. Grant. 
Capt. W. R. Greene. 
Capt. George Gow. 
Capt. O. G. Hassard. 
Capt. J. E. Holmes. 
Capt. G. G. Hume. 
Capt. F. W. B. Kell.v. 
Capt. H. Lionais. 
Capt. F. R. Mallor\. 
Capt. V. C. Mulvey. 
Capt. A. E. Mullin. 
Capt. B. L. Neiley. 
Capt. G. H. A. Stevenson. 
Capt. L. N. Trudeau. 
tMajoi- W. B. Clayton. 



Capt. G. C. Bonn.\ castle. 
Capt. T. C. Bruce. 
Capt. C. D. DesBrisa\ . 
Capt. W. Y. Hayden. 
Capt. Jas. M. Magee. 
Capt. H. L. Mitchener. 
Capt. S. H. Simpson. 
Lieut. J. T. Adams. 
Lieut. S. G. Alderson. 
Lieut. N. S. Bailey. 
Lieut. D. J. Bagshaw. 
I.,ieut. J. A. Beatty. 
Lieut. P. C. Briggs. 
Lieut. T. W. Caldwell. 
T ieut. C. E. Cnmobell. 
T ieut. V. V. Cashman 
Lieut. Karl Damon. 
Lieut. J. M. Deans. 



Capt. 


A. 


W. Winnett. 


Lieut. 


K. 


McMeekin. 


Capt. 


C. 


F. Walt. 


Lieut. 


B. 


P. McNally. 


Capt. 


J. E. Wrig-ht. 


Lieut. 


E. 


McNeill. 


Lieut. 


H. 


F. Alford. 


Lieut. 


H. 


C. Macdonald. 


Lieut. 


G. 


Atkinson. 


Lieut. 


J. 


W. Macdonald. 


Lieut. 


R. 


H. Atkey. 


Lieut. 


E. 


D. Madden. 


Lieut. 


W 


A. Burns. 


Lieut. 


V. 


C. W. Marshall. 


Lieut. 


C. 


H. Bray. 


Lieut. 


L. 


L. Matchett. 


Lieut. 


G. 


W. Bray. 


Lieut. 


G. 


A^. Morton. 


Lieut. 


H. 


Clarke. 


Lieut. 


J. 


F. Morrison. 


Lieut. 


A. 


R. Currie. 


Lieut. 


J. 


B. Morison. 


Lieut. 


G. 


H. Fowler 


Lieut. 


C. 


H. Moore. 


Lieut. 


A. 


A. Garfat. 


Lieut. 


P. 


E. Picotte. 


Lieut. 


W 


H. Gilroy. 


Lieut. 


H. 


Ross. 


Lieut. 


D. 


H. Hammell. 


Lieut. 


J. 


Roy. 


Lieut. 


J. 


W. Hagey. 


Lieut. 


W 


A. Sangster. 


Lieut. 


E. 


W. Honsinger. 


Lieut. 


J. 


F. Shute. 


Lieut. 


E. 


C. Hutchison. 


Lieut. 


D. 


P. Stratton. 


Lieut. 


R. 


Jamieson. 


Lieut. 


R. 


C. H. Staples. 


Lieut. 


J. 


L. Kappele. 


Lieut. 


E. 


S. Tait. 


Lieut. 


E. 


J. Kelly. 


Lieut. 


L. 


A. Thornton. 


Lieut. 


O. 


Leslie. 


Lieut. 


H. 


P. Thompson. 


Lieut. 


A. 


G. Lough. 


Lieut. 


H. 


P. Travers. 


Lieut. 


W 


G. MacNevin. 


Lieut. 


D. 


D. Wilson. 


T^ieut. 


C. 


E. McLaughlin. 


Staff 


Sgt 


Jas. G. Roberts 


Concentration Camps 








Lieut. 


R. 


L. Dudlew 


Lieut. 


AV 


H. McLaren. 


Lieut. 


.J. 


Duff. 


Lieut. 


G. 


A. Munroe. 


Lieut. 


J. 


N. Dunning. 


Lieut. 


Otto Nase. 


Lieut. 


A\' 


. R. Eaman. 


Lieut. 


H. 


A. Nesbitt. 


Lieut. 


R. 


W. Fell. 


Lieut. 


J. 


G. O'Neil. 


Lieut. 


D. 


M. Foster. 


Lieut. 


W 


H. Reid. 


Lieut. 


R. 


W. Prank. 


Lieut. 


J. 


W. Reynolds. 


Lieut. 


J. 


P. Gallag-her. 


Lieut. 


T. 


E. E. Robins. 


Lieut. 


G. 


E. Gimilan. 


Lieut. 


W 


J. Rutherford. 


T-ieut. 


.1. 


S. Girvin. 


Lieut. 


H. 


A. Simmons. 


Lieut. 


P. 


J. Healey. 


T ient. 


J. 


A. Stewai't. 


Lieut. 


G.H.Hollingshead 


Lieut. 


E. 


L. Thompson. 


Lieut. 


H 


C. Jeffrey. 


Lieut. 


B. 


L. Washburn. 


Lieut. 


C. 


M. Joyce. 


TJeut. 


V. 


D. Wescott. 


Lieut. 


Frank Knight. 


Lieut. 


G. 


A. Wilcox. 


Lieut. 


T. 


H. Levey. 


Lieut. 


C. 


E. Williams. 


Lieut. 


H. 


<^. Mann. 


Lieut. 


E. 


H. Wil-on. 


Lieut. 


D 


W. MasseA'. 


Lieut. 


J. 


H. Wiltze. 


Lieut. 


^\' 


. J. AIcEwen. 


Lieut. 


Ka 


rl F. W^oodbury. 



fActing Chief Dental Surgeon, address, Ottawa. *Lieutenants rank as 
Captains while overseas. C.A.D.C. over«<^c,c, addre'^'' — ^Care Chief Dental 
Surgeon. Canadian Expeditionary Force, Folkestone, Engr. 




ti 



-w^- 



'i^ 



4 ^-^*"-^ 



(*.i|>t A. l*ubord. 
('apt H T .MinoKUf 
Cr|»I I* I' Shiw 



Divisional Officers 

ru|ii. \V. a Tr<*lfnrcl 
<'mit tWn K. Thorruion 
•'iipl W O TtwimpMon 



«*«pt KM 
(Vipt. J. M V. 
<'«pl. W. W. V% 



ATTACHED TO CORPS OTHER THAN C A.O.C. 

Overseas 

Miijoi I* r Kiill i<lie>. 5Mih Kill I ('apt. K. II. 8pnrk*. ^J uw a'» I 
Mitjoi !•'. T. «*uKhl!in. 25th ltatti*r> lloitp.. <*alr«> 

(\ipt. K. i\ Cnmpbi'll. I.'tnl llatt Ciipl. J U M> : 

i'a|>t. i^hait. \. CorrlKMii. Arin> S»r\f»-«' Llrut. A. II I .• 

(*t>rp« IJrut. H. J M« l«»uf»(i. Ut*l lUt: 

Concentration Camps 

Ijifiit «'•>! M !•• \i iiintriiiiK. I. 'ft. \I .).ir N. }4«*hnirr iiil. I:.f 

MjiH ; \. I* J. 

M:iJor H \ ('roll. 10th <*.M.l: ... C. K v^ 

Major Niil Smith. IHiMh Itatt. 

UNDERGRADUATES 
Overseas 



F. 11. Itai I V. (*.A.I».*V 
A. Charnb.rH, CA.l>.»*. 
K I: I )i\Mii. 7li«t Matt 
J K I»..i, H. <'..\ 1» «• 
J. K. Irwin. (VA.I>.«V 
.\. W. JonrH. <•. .\ IM' 
r V I,;illy. t\ X.IHV 



J. «J. l.*iirmuur. t'.K.A. K S M< 

II. «. I^cntr. I' \ !»r I! V M 
W <• I.. 
«• I' M 

C. ^ ^"^ 

It. a Mr<}ulrr (llHlUh II W 

<'orp»»» '• " 



W«lk. 



Concentration Camps 
LiMUt. K. M lUiibour. 61th llntt J. T Irwiii. « 



H. 


<J M- • 


.. . .v,l. iiun 


a «; 1- ' 


A. 


K • 


;h Itntt 


A N 


K 


«;u 


' ' 


J M ^t 


H. 


<;i. 




\V 


il 


M 1 


im 


• • 


J" 


II llu 


. llUU.HUll. l'..V.l»»' 


1 1. 1' 




Mnjur 4*. ^ )UW. Ulh lUU. Uh lUiAAOc 



Oral Health will apprr^' 
tlon thAt wtll ni4kr ' 
•tantly ava 




ORAL HEALTH 



EDITOR 

WALLACE SECCOMBE, D.D.S., Toronto, Ont. 

CONTRIBUTING EDITORS 
GEORGE K. THOMSON, D.D.S., Halifax, N.S. 
F. W. BARBOUR, D.D.S., Fredericton, N.B. 
ASHLEY W. LINDSAY, D.D.S., Chengtu Sze Chuan 
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y. 
T. W. WIDDOWSON, L.D.S., London, England. 
J. E. BLACK, D.D.S., Vancouver, B.C. 
MANLY BOWLES, D.D.S., Winnipeg, Man. 
J. A. C. HOGGAN, D.D.S., Richmond, Va. 

EDGAR D. COOLIDGE, D.D.S., Chicago, 111. 

RICHARD G. Mclaughlin, D.D.S., Toronto. 

Entered as Second-class Matter at the Post Office, Toronto. Sub- 
scription Price: Canada, $L00; Other Countries, $1.25; Single Copies, 25c. 

Original Communications, Book Reviews, Exchanges, Society Reports, 
Personal Items and other Correspondence should he addresse-d to the 
Editor, Oral Health, 269 College St., Toronto, Canada. 

Subscriptions and all ibusiness communications should be addressed 
to The Publishers, Oral Health, 269 College St., Toronto, Canada. 



Vol. VI. 



TORONTO, FEBRUARY, 1916 



H 



E D I T O I^I ALi 



No. 2 



H 



War Time Demand for Dentists. 



Special Summer Session, R.C.D.S. 



WAR conditions have occasioned an acute shortage of Cana- 
dian dentists. Aside from the 125 licentiates who have 
joined the recently organized Canadian Army Dental Corps, 
and who are either overseas or working in one of the many concen- 
tration camps in Canada, a large number of Canadian dentists have 
joined other branches of the overseas service. Canadian battalions 
are being recruited with such rapidity that the serious problem of 
supplying an efficient dental service for these forces now confronts 
the Canadian Army Dental Corps. In addition to this demand, 
the members of the C.A.D.C. overseas are literally working night 
and day, and their numbers will have to be greatly augmented in 
the near future. In many cases the corps is so undermanned that 
little more than temporary relief from pain is undertaken. These 
factors indicate an increasing demand for Canadian dental surgeons 
as the war progresses. 

The time has passed for Canadian dentists to join any branch of 
the service other than the Army Dental Corps. The need for dental 
surgeons is so great, and the number of qualified men is compara- 



OKAl. HKALIH 99 

lively so limited, that no citi/cn qualified to practise dcnlHtry can 
f)e spared for oilier branches of active ser\ice 

1 he Koyal Collej^e of Dental Surgeons of Ontario has a total 
registration of 323 students, made up of 109 freshmen. 86 topha- 
mores. 72 juniors and 56 seniors. I lie great majority of mrmben 
of the senior class, who are now about to graduate will, m all |iroba- 
bility. go overseas as members of thr [Rental Cor|>«. A ♦ 
ixamination has been provided for all undergraduates who«e rii... ..!, 
duties call them away from college before the regular ipring exam 
inations. I his special examination made it possible for a ftudent 
to get credit for his year's work, and was made available upon 
api)lication at any lime following the I 5lh of rel>ruar>'. 1916, and 
was concurred in by the L riiNersity of I oronlo. 

It has now been decided to hold a special summer sesaion for the 
I>resent so{)homore and junior classes. Iliis will eliminate the usual 
.«»ummer vacation and enable juniors to graduate next fall instead oi 
the spring of 1917. and sophomores to graduate in the spring ol 
1917 instead of the spring cf I9|H Not all of the memlwrs of these 
classes will attend, but a sufficiently large number will no doubl 
attend the summer session to assist materially m meeting the unusual 
demand for dentists, which will surely obtain during the balance of 
the war. I he summer session will co\er the regular work of the 
course and regular fees will prevail. 

Upon graduation, students who have availed themselves of ihr 
summer session will be issued certificates, provided they attach them 
selves to the Canadian Army Dental Corps L'|>on the other hand. 
if the graduate does not join the C.A D.C. his certifKale will Ix 
withheld until the time that he would ordinarily receive it. 

The Board and faculty of the Koyal College of Denial Surgeons 
of Ontario are to be congratulated u|H)n this arrangement, which 
seems to riieet a sjiecial need in a very - i''*^tctory way 

A Modem ••R.|.\.u. Winkle." 



a 



IN the AmcrHcin Journal of Singcrv for Felnuarv /« 
prominent editorial entitled "Concerning the I eeth." m ^nich 
statements aie made c«incrrning the dental profession that are 
so absurd and strikingly foieign to the real facts at to make the 
reader wonder whether the editoi were |>er|>etrating a strange )oke ofi 
the leaders of that valuable journal, or whether, a* i* mm! ' ' 

the writer has been in the land of profession '' •' '-• ^ ' '' 

"twenty vears." What will the meml>ers of : 

the State of New \otV. who have for the |>aft "Iwentv vear^'* hern 

in the \an of the dental profession educationally and 

say. think, and (l\ when they read the following quota ti mi ir-w.. ...^ 

said ediloriaP 



90 ORAL HEALTH 

"Medicine until very recently has failed to take cognizance of the 
teeth. Dentistry developed as a cognate but independent art. With 
meager pieparation in the fundamentals of pathology and the 
principles of surgery, dentists have gone on in their own way practic- 
ing this very important branch of surgery. So long as they confined 
themselves to extracting decayed teeth and making artificial dentures 
to take their places, they were well within the range of their capa- 
bilities; but when they undertook the treatment of teeth which had 
lost their blood supply and innervation and had become foreign 
bodies, a degree of knowledge was required which the education of 
the average dentist did not provide. Thus for a long period root- 
canals, containing dead nerve and other structures, encased in a 
mineral wall, have been closed and hermetically sealed with caps 
and fillings. 

"In the course of time the tendency is for these canals to become 
infected, either directly or through the blood and lymph streams. 
Being closed externally by caps and fillings, drainage is impossible. 
The infection proceeds inward, passes through the apical foramena, 
and attacks the socket lining, and then the bone at the apex of the 
socket. The backwoodsman and the poor, not having access to 
dentists, permitted their teeth to rot off, and thus were always pro- 
vided with drainage of their root-canals; they have been spared the 
physical ills and disasters which visited those who thought they were 
more enlightened and who went about with "a mouth full of gold." 
It is difficult to think of a more dangerous and unsurgical procedure 
than the sealing in of root-canals, containing dead animal tissue; but 
this is what dentistry has been doing for the past twenty years. Per- 
haps we should not say dentistry, but dentists; because there have 
been a few enlightened men in this profession who have understood 
the pathological principles involved and have conscientiously cleaned 
out and filled root-canals down to the very apex before sealing the 
canal with cap or filling. Still the great majority of people, who 
have undergone dental operations upon dead teeth, have had this 
surgical crime perpetrated upon them." 

Cft ^ ♦X* rf* •!• 

The editorial was signed J. W. P., and containing statements such 
as have been quoted needs no comment. Perhaps the less said the 
better. It sounds its own death knell. However, it would be in- 
teresting to know who has been J. W. P.'s dental advisor during 
those dreadful "twenty years" of pent up infection. 

We humbly commit the whole matter, including the twenty years 
of slumbering infection as well as the dental education of J. W. P., 
to the tender mercies of the New York State Dental Society with 
the most respectful request that all precautions be taken to avoid any 
somnambulistic relapse during the next decade. 



The Lack of Dentists at the Front. 

ADKNTAL piirRoon. i >.• . .ii. > wr\ti*n 

to th(> Lancet for Janu 191C. to the 

«>rT(Tt that he had n-ad tn the T«'nipii. of 
Paris, that a bill wan about to Ijo introdiir«d by 
the French Mlnlnter of War to provltl** an armx 
d*nta1 stTvlcj*. It waH propoH- •' '>c 

qualihed dcntiHts li; the ho.sp 'o 

create an army dental corps wlui the rank of 
Hdjuiant. providing a fler^'lce it t» '- nt. In Ihc 
hospitals, and wh«-n ver troopn w* to pais. 

Thus Australia. Canada, and Fr.it < •• a<l:i<it thr 
n«>«'d of a Hpecial corps, and no doubi the)- b«T«* 
found that at 'ho front It is the dmtist that Is 
rrquiicd mon- than t" 'or. ^b 

aulhoritl«'S srrni d»ti-! to Mhi ••« 

to one of the chief needs of thr amiy at Ih^ 
present moment. We shall soon hnvo milltona of 
soldit-rs in the fh'ld. says ihf l«";»4- Artt'-r. yet 
it has iM'en rr<«.nily stated that thf numttor of 
army dental surKi'ons in Franco, excluslvo of 
those with the Canadians, is only fortythro* 
Mranwhili- inauy vounR \r- 

jji'ons and stud":i»s will r<- »n- 

flcription law, and unlt>ss the an < show a 

llttli- better appreciation of th»* i*«i. » "ny 

in-arly all thi's** >()unir m»'n will \u- •© 

the ranks of thi* (omli »it 

to be formed into an u: is 

so urgently needed <:r«'at ind«*ed baji b«>en lh« 
obstinacy of lb- -•posInK Ibis pro 

|e<t. .Nt'W Yoi 




Major W. B. Clayton 
Acting Director of Dental Services, Canadian Army Dental Corps 



ST 



m 



Jr 



ns 



ORAL HEALT/V 

A JOIHNM IliM ^1 \NM«- MH{ I III- -O(N<X0r 
PRKYKVnoN.*- AS U K.I.I. 4S IIIK - I'ol M i n> M Hf " 



m 



m 



\(H . ^ 



|n|{( jN I ( ►. \l \i;( II. |«»|(> 



No. 3 



Parlial Dentures 



W. E. CUMMIK. D.DS. L.D.S.. I*K()KF-S-SOR pROsTHimc 

Df.ntistky and Appi.ii I) Dkntal I^nsKs. Koyal 
CoLLKCK OF Dkntal 5uRctONs. Iokonto. 



Our of tli<it which is unquestionably the big thing in deoUifUy 
to-day. namrly. clinical and X-Kay proof of frcqurnlly grave 
and occasionally fatal systemic disorders arising solely fron 
ceiities of infection, and these often at the end of nn|>erfect root a 
work, unsuspected dead pulps and similar. aggraxAtcd by 
arising out of improper digestion due to imperfect maslicalion. and ad- 
mixture with saliva of bacteria and bacterial poisons resulting ' re, 
loose, or discharging teeth, irritating and un^amtary crowns - •'^. 
improperly in.ide and gum margin de^f"'\"" 'Iim-^ m 
ber saddles, and other all too frecjuent • :; 'T. 
arises, next in importance to the need of a rational root canal and 
peridental treatment within the reach and means of the publK ihnnigh 
the a\erage and near-average dentist, the need of ,i simple. %,tnitAfv. 
non-irritating and mechanically efficient system of roLxuiK U»»l 
teeth, also well within the reach and means of the publn thrtmgh 
the average and near-average dentist and his eflKient and falKful 
ally. \\\r laboratory man. With the indications |K>r ' «f 
the pieseiit time t<n\.uds extraction of aM • — ^•* " '^ 
ciimcal signs and \ Kay to be not amen i 

time to known methods of treatment and ai>ex surgery. M wdl M 
a strong disinclination on the |>art of the thinking denti«l t tIo 

healthy teeth, the engineering as|>ect of the average srroi eoeTuuwJUi 



94 



ORAL HEALTH 



mouth, after these preHminaries are disposed of and the remaining 
teeth and roots are healthy, will show a considerably less number 
of anchor teeth or roots for the future artificial appliance than here- 
tofore. The writer confidently believes that a glorified descendant 







Figure 1. — A common example of destructive dentistry, clasp fitted to the 
gum with hig'h lingual base, (a) Before "settling" invariably produces caries, 
(b) After settling produces caries and pyorrhea. (c) Common example of 
above vicious dentistry; rubber or gold stringer with fitted clasp. (d) Ditto 
seen from above, (e) Proper construction. See Indirect Retention. 

of the present "ordinary" partial dentures and fixed bridges (both 
faulty in so many respects) bearing the hyphenated name of 
removable-bridge-partial-denture, or better still, just partial denture, 
will largely solve our problems for all forms resting on the 
mucosa, or teeth and mucosa; removable, sanitary, non-irritating to 
gingival margin, comparatively simple, and therefore inexpensive to 




Wire. 



LINGUAL 

Bar 




LtNQUAL BAtL 



BASE OF DENTURE 
AWAY rnOM QlhfCtVAL 
MAROIIV 



**01E NON INTEHI^^KCI^CB 
QlNGiyAL t^AIZClN. 




Proper construction for atoove. (a) Proper clasp fitted and contoured to 
opposing convex surfaces: at point of widest cross-section joined to base or 
lingual bar with 14-gauge wire, (b) Showing position of base of denture, bar 
and 14-gauge wire (latter in embrasure), (c) Side view of above. Note clear 
gingival margin. 



OK AL H LAI. I \\ ^i, 

construct, capable of modifications in event of loss of teeth or rooU, 
and. best of all. well within the reach of the |Kxketbookf o( our 
patients and the handicraft of ourselves and of our Uboralory 
associates, the latter combination necessary for economic and nuub* 

mum production. 

Partial dentures may be said to be artificial restorations resting oo 
the mucosa, or mucosa and teeth, and usually retained directly or 
indiirctly by natural remaining teeth, the weight of mastKalion car- 
rircl by the mucosa, and in many forms with the assistance of the 
teeth themselves; this preferable where\er |)Ossible. as leeth will bear 
roughly from six to ten more stress than the mucosa. Strictly s|)eak- 
ing, a bridge, be it fixed or removable, rests on roots only %^h- 
out the assistance of the mucosa, as in the sister science of engineer 
in^. in which bridges, in sj)anning an interspace, rest ufion |ire|>arcd 
abutments. 

A study of partial dentures involves, in addition to certain general 
considerations, a study of the natural leeth (unaltered or |)ref>ared 
for abutments), presenting most frequently for the retaining force; 
and the various parts incorporated in the remo\able artificial |>art«. 
such as retaining de\ices. bases (preferably metal), to whKh thr 
teeth are connected by the attachment, usually \ulcanite. better, gold. 
or porcelain. 

Gi:n f.kal Con sidkkations. 

r^artial dentures in the years that have |>assed have acquued a 
re(jutati()n as caries and pyorrhea producers second to none. chicHy 
from one or both of two reasons. Of these. |>erha|>s the place oi 
honor (?) might be given that peculiar and unixer^allv u*rd .ym\ 
universally to be condemned form of clasp which Muigl) hi* the Uh^U 
around the gingival margin, holding by capillary Attraction decoin 
posed food in solid and dissolved form at a |>osilion on ihe tooth 
least able to resist caries, and which, after seltl • 

occurred, adds peridental destruction to canes pi * 

melancholy cycle prineeds rapidly and surely to .i. Auction of the 
tooth Ihe second place on the roll of tooth tissue dr*truclK>n may 
be safely given to that unfortunate form of saddle, or mucosa 
touching element which, be it gold or vut. > * t high 

on the Imgu.il maigm of the t(H)th. co\enng a:.,: , ■ down. 

and inilaling the gingival margin aUo to it* sure and rapid dc*lruc- 
iKMi. I ig I and 3. Concerning the pathology. Dr. Harold Bo». 
of the Department of F'athology. Royal College Dental Sirgeons. 
says in part : 

"I he attitude of the denial profe^Moii to-day toward the pfrKr%a- 
lu)n of the gingivae shows tliat this Mibject has become one ol \ital 
interest to all of the better class of men in the iHofessmn NX r know 
that this ti.ssue is the place of origin of serious jMithologxal coor' rwoi 



96 



ORAL HEALTH 



which are attracting a great deal of attention to-day from prac 
titioners in general medicine and surgery. 




3a QOOD. 
SADPkE) A^aY paori 
QlNClVAt- MAdQIN. CLASPS 




3a DENTUae 





3b fa/«. 



Figrure 3. — Series of designs for identical condition (front ten in, balance ab- 
sent) of diminishing- quality. Note complete lack of gingival interference in 
3A and the reverse condition in SE. 

"Examination of histological sections showing the gingivae in its 
proper relationship to the surrounding tissues, shows that this tissue 
is divided into three parts — the body, the free gingivae and the septal 
gingivae. We can see in a glance its close relation to the peridental 
membrane and the alveolar process. The body rests on the alveolar 
process, and is attached to it by the fibres of its periosteum. It is 
attached by the first group of fibres of the peridental membrane, 
known according to Black as the free gingival group, to the roots of 
teeth at their gingival portion. The free and septal gingivae rise 
from the body and surround the enamel of the crown of the tooth at 
/ the gingival. The space between the enamel and the free gingivae 

^ i which covers it is known as the sub-gingival space. 

^ "Where a clasp, on account of settling or from other causes, has 

come to the repth of the sub-gingival space and has impinged on the 
peridental membrane, an intense irritation is set up. An increased 

[J^ supply of blood to the part follows, and inflammation is established. 

f Deposits of fermenting and decomposing food are rarely absent, this 

giving an added irritation and adding caries production under the 



)^ 



OKAl. ULAl. i H 97 

mo5t favorable circumstances. Infection followt, and part of the 
pcriclcfital membrane is destroyed. We know that no alvcoUf pro- 
cess over any part of the root will remain without a (>cridefilal mcni 
braiir. When this is broken in any part, the alveolar proccw to 
winch this portion is attached is absorbed. 

**Again. when any part of an appliance rubs or prfsso on the 
gingivae in such a way as to make an irritation, nature, as in all 
injuries, tries at once to remove it and sends an increased S4j|>f>ly ol 
blood into the dilated blood vessels. I o make matters wof»e. m 
most cases the surface of the enamel in the subgingival space has 
been etched, owing to the dissolution of the cementing substance from 
between the enamel rods by former fermentations. Continued |>fe»- 
sure of the free gingivae against the sharp enamel rods < an 

injury to the inner portion of this tissue, greatly adding lo lii. miiaro- 
matory .iiid caries producing condition. 

"Nature, being unable to remove the sources of irritation, at once 
undertakes to remove by absorption the crest of the alveolar process. 
so that the injured tissues may fall to a new level and return to a 
state of health." 

I he above process continues to one of two endings, either a 
removal of the offending clasp or saddle and the substitution oi a 
proper clasp or saddle kept in each case well away from the gingival 
maigin, or the certain destruction of the tooth, either from pyorrhea, 
caries, or both. 

I he cliiucal experience of all. as al>ove interpreted, oflcn a con- 
vincing proof of the first and most important essential m design of a 
partial denture, or. for that matter, any kind of artifKial r 'on 

of lost teeth and assocuited tissues, namely, the netr *" * 
nil fjiiits, he //icV i/tiip5, hands, half hiinJs, hoods, itijj — 
aiva}} from the free margin of the gum, let alone $ini(mg fce/trem lh< 
loot and the free margin. Kemovability is also a |>rime requtsile. 
as is skeleton design, using bars of oval stiff wire, joining » ' ' " 
united by solder, rather ih.ui covering the wlu»le of the rem.* .• .^^ 
vault or gingivae with metal plate, except in instance* m which ad- 
hesion is desired as an auxiliary retaining force, (Pig. 3.) Noo-lll- 
terference with the natural movement of the teeth and roots, at clearly 
demonstrated by Dr. Herman S Chaves, of New ^ cnk City, » abo 
a prime consideration m design. I he use '^^ ..>•-.? ^ V .„.. r^i^.r.^*. 
with cuiveti contacts pernutting this, and |>erm 

movement of partial denture, following its elastic mucosa MiitfKitt. 
the springy character of the skelet»>n metal construcluKi. and the more 
or less cushion-like characteristic of the nuicma. all lend towaid th» 
end. Teeth or roots bear nnighlv from six to ten times the weig}^ 
that the mucosa will sustain, and the ol)\ious les.«on in the drugn 
of partial ilentures is. whenever |H>s-sible. rests of 14-gauge v*tre. 
curved to prevent slipping away, resting in inlays placed in natural 



98 



ORAL HEALTH 



teeth and soldered to saddles, at one or preferably both ends of 
saddles. (Fig. 4.) The above contingent with peridental conditions 
of the tooth or teeth, space for wire, and similar. Also the logical 
procedure, after the piece is completed and adjusted in the mouth, 
by careful use of carbon paper and stone, a slight cutting of artificial 
porcelain which will allow the natural teeth or roots to obtain and 








e^TTen 



Figure 4. — Rests fitted in inlays, left hand drawings showing part of a bar 
lower, upper drawings sectional view of the same. Rests may be assembled on 
the framework of a denture, the wax pattern of inlay then made, and the den- 
ture with the rest or occlusal stud pressed home, allowing the rest to sink 
into the softened wax at masticating pressure on the denture; or the slot may 
be formed on the occlusal of the inlay, and the rest subsequently fitted to the 
inlay on the cast. In the latter procedure it is advisable not to solder the rest to 
the framework, but to try in the mouth with rest attached to the framework in 
wax only, thus securing a position of ridge-stress, and thus dividing" the stress 
between the saddle and tooth in desired proportion. 

carry a larger percentage of stress than artificial porcelain finding its 
ultimate support on the mucosa. Resultant stress of all kinds dur- 
ing function should be carefully worked out and the design conformed 
in such a manner as to place no undue stress on any part either of 
the artificial or natural mechanism. Some examples of the principle 
will be mentioned later under the caption of Clasp, Indirect Retention, 
and Anatomical Articulation. Designs should as far as possible 
provide for the extraction of a doubtful tooth or root and suitable 
and inexpensive readaptation of the partial denture to new conditions. 

Examination. 
Probably the first procedure following the initial appointment is 
the procuring of the history of any doubtful teeth or roots with skia- 
graphs of all, as well asa thorough examination into surface and 
peridental conditions. In event of doubtful success of accepted 
methods of root canal or peridental treatment, apical surgery or other 
known methods in a reasonable time, extraction, curettment, or similar 
treatment must seem necessary, for no precept of modern dentistry 
should be more scrupulously observed than the thus safeguarding 
of the patient's future or present health. Carious recesses should be 
either excavated or temporarily filled, pure phenol sealed with zinc 
chloride cement tending to desensitize without pulp-danger from its 
delayed removal. Any attempt at design of partial dentures while 
the health of any tooth or root remains in doubt may be subject to 
such revision as to result in considerable wasted effort. 



OR Ai. H r A ! I H 99 

i>TUDY MODF.LS. 
Quite as necessary in the design of a partial denture (oiiliide ihr 

rxlrcmcly simple forms) to a drntist. as the blur printi to the archi- 
tect or machine buiidrrs. arc ihr study mrxJels or sketches or both. 
Stresses, resulting stresses, methods of retention, direct sa uidtrcd. 
space for constructional parts and teeth, necessity or no for opromf 
bile, tooth or teeth involved if this is necessary, position and size ol 
constructional parts (prf)viding gold ' Rold. or gold agatn^ 

natural teeth rather than porcelain, .i ....^ excessive wear), aiKi 





Flifuro 5. — torni for rubber fitninp for !• • 
in tho article were workiMl out from Ihr mp 

rnnk«>r <-aii mnkv '\ Mtamp from innpertlon of ^Ik»^«> vut*. 

similar preliminary considerations may all be plotted out with reason- 
able decree of accuracy. Preliminary to this, (x'ncil sketchr* on a 
printed or rubber-stamped set of teeth of 14 (f'ig. 5) (third "uJ.ir 
may be sketched in if necessary) may be quickly made until a v. 
design is evolved. 

Abutmknts. 

While any lengthy discussion on prepared .ibiilmmls nrghl %rrm 
more relevant to a discussion of crown and bridge worl '* • * 
j)rosthelic dentistry, yet. with the increasing use of ii 
retainers soldered to these, the dividing line l>etween these l%iro 
branches is fast becoming so indistinct as to l>ecomr ol>lilrfaled rn 
tirely. and the writer feels justified in making a br * * rciKe At the 

outset, consistent with principles of mechanical c ;; \ and arloCiC 

harmony, each given due proportion in each proJ>lem. it may be defaH 
itely stated that mitural tcclh s/tou/J. in every case, he l/iev eilher fot 
retaining nrtifhiul f.uirts in position, or assisting in the stress of ifuislHa- 
linn, or hoth. shotilil he titilizcii. so fur as thcv nuiv he. in their tutlunal 
and uimhcii'd foiiix. I his being imi>osstble. rwtfufi^' Untha ih^in the 
ahsolutc niininniin of cutting tin J niter ation cv with 

mechanical principles and future possihle pulp ns should he 

tittcniptcd. cjuile apart from the consider »il ion i>t 
bilily to future pulp complications, loss of tim-- ^- ' 
inaigm in the mouth t)f the patient, the r\ef ii> 
a larger number, and serving them well as well as ec> 
knowledge of rtxil canal |H>ssibililies (and m OMiny cat- 
ties in the hands of the aNeia«e man) f 
ground upon which this piiiKiple stand*- ;-...• 



100 



ORAL HEALTH 



importance for certain methods of retention, fallen more or less into 
disrepute on account of their misuse in incompetent hands (notably 
the clasp), as well as furnishing us with another notable series of 
possibilities given to us with the advent of the cast gold inlay in the 
direction of the retaining-element-carrying possibilities of these inlays. 




-cG-MCn/t 



Figure 6. — Short preparation of cuspid for direot retainer element not carry- 
ing stress, as Roach, etc. (a) Uncut tooth, (b) First cut, shown from lingual, 
with knife carborundum stone, (c) Ditto viewed from labial, (d, e) Lingual 
and side views of next cut, made with fissure bur in the right angle handpiece, 
(f) Inlay with Roach ball in place, (g) Showing groove in inlay opposed to 
groove in cavity wall. (See Figure 7.) 

Alterations by cutting of natural teeth seeming necessary, the 
minimizing of this cutting, consistent with strength, should he always 
kept well in mind . (Fig. 6.) In simpler forms of inlay, the placing 
of opposed grooves in the inlay against opposite opposed grooves 
made in the cavity after withdrawal of wax gives a very decided 
element of strength against dislodging stresses. (Fig. 6 G). In the 
compound forms the use of one, two, and sometimes three pins of 




Figure 7. — A, B, C, D, showing use of opposed grooves in Inlays in sec- 
tion. E, F, tapered locking pin suggested by Dr. O. S. Clappison, Hamilton, 
Ontario. 

20-gauge metal, located in suitable positions, subsequently threaded 
to be received into holes also threaded, is of advantage in addition 
to above. In the M.O.D. forms the opposed groove and occasion- 
ally pins and diagonal tapered looking pins materially assist. (Fig. 7.) 
The necessity or no for devitalization in these instances is largely 
a matter of separate consideration depending on such conditions as 
age, history of pulp, behavior, X-Ray information, amount of 
caries, amount of stress to be borne and similar considerations. More 
extensive preparations involving pulp destruction seeming necessary. 




Figure 8. — Steps in construction of lock screw, using inlay and post as 
example, (a) Preparation complete, (b) Wax pattern and post fitted, (c) Inlay, 
(d) Hole for locking screw, (e) Ditto in tooth, drill guided by hole in inlay 
already made, (f) Hole in tooth enlarged, (g) Inlay being tapped, (h) Lock- 
ing screw in position, turned permanently home while ceiment is still unset. 



ORAL HI. A I. 1 H 



101 



conditions appear more properly embraced under the ca|jIioo oI 
crown and bridge science rather than prostlietK drnlulry. For 
restoration involving the anterior crowns ujx)n which retaining ele- 
mrnls arc to be atlachrd. the writer sees no ■ ' ' *n lo the hngiial 
half band. puMclcd that it is well fitted to a h.^ . ...:^ual root |iortiOQ 
and kept above the gum margin, which construction affords a drcidrd 
gam in strength over the non-band forms againsi stress ijroceedmf 
from the lingual, not to mention a decided minimi/ing of tooth cutting 
I' or inlay with post, half-hood with post, and similar pref>aral»ons. 
a locking screw made from the wril-known Howr screw |>osi arui 
accurately fitted after cementation, mechanically provides againsi 
movement iii the only remaining direction of egress (Fig 8.) 






A ^t 

FlKUrr VIII Two f«-ature.H u: 
crown Into dlMrcputi< (n) nrit mr 
and <'iirrlfd bolow ihf k' *l>> i'it»i>«i ■ 

food find nwny from ih»' . marKln. rind k- 




■MEiVBi. 
■ narste. 



Properly constructed and placed, the shell crown (Kig \ ill.) hat 
the cardinal advantage of strength which gi\es it its |>eculiar po»itioci 
in dentistry. Irom a root prepared to slightly converge from the 
gum line up. an impression and Spence's plaster cocnpound cast ts 
made, band lilted to this above the iiuni line, contoured to shed food 
away from the gingival margin, heated and in\erled in softened fiaid 
wax. occlusal surface formed and carved in wax from a "bile" bo*h 
in rest position and side movements, and subsequently ca*l. the 
crown then lined with soft wax. piessed back on the rtxjt. hlletf \%ilh 
^pence's plaster c-nm|)()und. and llu*ii rrbu? m^h«-.l ^^.^llh \« ill produce 







lit:. IX. Slop* ii' 
crown, (b) Ditto i> 
yrllow %' ,\ ■ • ■■■■ 

whfn* II • I 
(d« I'rowi. .. 
iiK'ilnitt .K|M'i> 
turnInK Ihv •. 
N.R. Koot. B.KO. t«prnc«*a i*l«»tvr iTitnpuuntL 

a crown of such accuracy that when pushed lo place the conlractinf 
periphery of the band adapts with greatest precision (Rg !X ) By 
the judicious use of the Howe screw |H>st and gulIaiH-fihA »x>ri 
pl.ued in canals and renunetl from them in an amalgam e. 
restoration while still unset, preliminary to the pcct^ratwn ol ihr 
root lo receive a shell and ihe forming of a s|»ace m the occh»Al 



102 



ORAL HEALTH 



of a crown, the treatment of the root canals may be continued after 
the splint bridge or crown has been cemented in position, frequently 
avoiding annoying delays. (Fig. X.) 



l^Z^ 



a 




Figure X. — Process of building up a root, leaving- the root canals free for 
treatment. (a> Before. (b) How screw post fitted, (c) Gutta percha cones. 
(d) Amalsa.ni restoration (matrix). (e) Gutta peroha cones withdrawn, while 
amalga-m is still unset. 

Partial dentures are made up of a base, teeth, and attachment, 
usually vulcanite or gold (soldered or cast), and joining teeth to 
base, and retaining devices connected with abutment teeth. Re- 
taining devices or forces may be divided into three general classes, 
one in which the denture is held in its position without interlocking 
parts attached to teeth, crowns, abutments, etc., such as adhesion, 
various clasps, cribs, etc., and another class consisting of special inter- 
locking devices as Roach ball, and split tube, stud, ring and stud, 
wire and wire clasp (Gilmore) , split wire and tube, and others subse- 
quently referred to, and in each case connected with a fixed element 
attached directly or indirectly to teeth upon crowns, inlays with posts, 
splints, etc., and in a large number of cases rendering necessary 
devitalization of teeth concerned for firm attachment. The third, 
christened indirect retention, is an auxiliary used with either or both 
of the above. The great advantage over the retaining principle of 
the first-named class over the special interlocking devices of the 
second class, particularly in view of our present-day X-Ray knowl- 
edge of root canal operations, is easily patent, namely, that of non- 
necessity of mutilation of teeth. 



Simple Retention (Devices of One Element) 

Clasps. 




Figure 9. -^Rationale of proper clasp action. (a) Tenso friction only, less 
favorable type, (b) Bell shaped type most favorable. Free ends of concaved 
clasp approaching* opposed convexed surface of tooth. (c) Spreading of free 
ends of cla.sp to pass the point of widest cross section. (d) "Snapping" of 
clasp into position, as its free ends assume the same separation as in B. 

Perhaps one of the most useful, yet widely abused and ma- 
ligned methods of retaining artificial pieces in the mouth is the 
clasp, which, in a vast number of well-chosen, well-designed and 



OKAL UKALI H 



103 



adaptable cases is pre-eminent over all of our newest and most elec- 
tive forms of interlocking devices in this one res{)cct of greatcil 

importance in view of our knowledge of root canal ()Oi»ihilities (and 
inipossibililirs). namely, the non-mutilation of cither terth or imiIm. 
In conjunction with an indirect retaining extension, of whKh refefeoce 
will shortly be made, saddles of considerable length may be held 
firrnly in position, supported by a single clasp at one end of lh« 
saddle only. 
















FlKure 10. — Proper coniilructinn of claitp. (•) I»rr»r*'r Ha;«p (Ittfd 
toured to oppoMlnic itmvfx -^ ' At point • ri 

to bniie or iliiKual bur with ■ wlrt« ih ^ K««^ nf 

di-nturo. bnr and 11 »Cfiu»r«' \\ : • • 
nbovo. N«»t«« rli'nr KinKlvnl timrKln. 

nvetlon ln't\v«M-n rlnHp and baj**-. ftUkK- ■ 'i ■»» •^■m- j »».iii«;r.n ^^^ i .rn 
(Mty. 

Raiionalk of Clasp Action. 

Whilt* the rebound or spring of clasp against the toolh Mitmii up 
a friction is an important factor in clasp action, and all im; U) 

the case of a more unfa\or.iblr type of tooth, namely, wil; -^ 

sides, yet the most e(fecli\e cl.isps which gt> into |>otition 
"snap** so grateful to the patient, are those whKh mechanically con- 
form to the slight "beir* shape of the crown of that ly|>e ol toolh 
peculiarly well filled for clasp action II ni.iy thus In* noted thai 

in order to attack or remo\e a formed band cla»p from ♦uch a Icxith. 
lis free eiKl> imisl be sprung apart to a distance pri>j»oftion«l with 
llic l)( II sh.ipe of the tooth, thus ensuring a mechanical locking of ihr 
clasp III po'^ilion. (lig ^ ) 

Use and Abusf. of Cla^i 

1 he long bicuspid, molar or cuspid tooth (in ocdrt of |»«rfrrrnt e), 
of good peridental condition at the c\m\ of a ♦enr* And of more or 
less bell shape n<// iihovc the gingi\al margin, are \rr\\x N.r'! wi.XrA 
to clasp. /\ clasp lilted to one such as aUixe. can 
«|u.uler the circumference of the tooth, f/ie /oDvr nuv nitn o» 
kept well iihovc the gingival margin. unJ lo tht hiuc b^ 4 4 



104 



ORAL HEALTH 



gauge flattened platinum and gold Tvire or 18-gauge curved or 
springy wire (Weinstein) soldered to it and to the base. (Fig. 10.) 
The writer desires to lay special emphasis on the necessity of accur- 
ately shaping the clasp. A tinfoil pattern (Fig. 11), a MeIotte*s 




=^ 




A 



B 



Figure 11. — (a) Usually a soft metal pattern for a clasp cut from a parallel 
straight sided piece of metal, when adapted tends to turn gingiivally. (b) When 
curved as above follows the gingival margin about parallel distance. 

metal cast of the tooth, from individual impression in plaster, free use 
of the contour pliers and rivetting hammer are necessary to secure the 
result desired, using 24-gauge clasp metal plate. Following this plan, 
many teeth heretofore considered unfit for clasps, as lower first bicus- 
pids, cuspids, occasionally upper cuspids, may be effectively used, 
provided opposing convex surfaces may be found and free ends of 
concaved clasp fitted to these. (Fig. 12.) A clasp should be made 
of suitable stiff metal, cut curved, platinum alloy preferred, and should 






Figure 12. — ^Choosing suitable opposed surfaces of the same tooth for a clasp, 
(a) Showing different opposed surfaces AA and BB. (b) Side view of opposed 
surfaces at AA, unsuitable for clasp as pressure of free ends of clasp tends to 
throw clasp off tooth, (c) Same at B viewed from above, (d) Side view of 
opposed surfaces BB suitable for clasp. Opposed convex surfaces to which 
free ends of clasp are concaved and fitted, (e) Same as D view from above. 

be sufficiently wide to allow bulk of metal to ensure springiness (not 
less than 3 MM), in order to secure the maximum efficiency obtaining 
from the concaved-formed free ends of clasp pressing against opposite 
convex tooth surfaces. And most important of all, neither the clasp 
nor the base must ever touch, less impinge on the gingival margin, a 
construction which may be remedied in 95% of partial dentures now 
constructed by using the three-quarter clasp with 14-gauge wire to 
join to the base; a construction in no wise interfering with the health 
of the tooth and the surrounding tissues. (Fig. 10.) For short teeth, a 
narrow, thick cast clasp is indicated containing sufficient metal to give 
same grippy action as wide clasp on tooth. (Fig. 13.) On the 




Figure 13. — The cast clasp is indicated where the tooth is so short as to 
require a band so wide as would sink below the gingival margin, were it to 
contain sufficient metal to give it spring. The same gripping spring action 
may be secured by the narrow thick cast clasp. 



O I< A 1 . W \: A I . i M 



I0> 



other liaiici. tlir misuse of the clasp. Ki\x)t] ^hort. uniuitablc teeth, or 
such crudities as the flat clasp close to the gingival margin, enorclmg 
a little more than half the buccal surface! and mer({ing into rubber 
carried hi^h up on the gingival margin (Fig I4A); the shAped 

clasp following the gingival margin (f*ig 14B); •^- ^ ? clAip 

between two short teeth with base high on lingual ( *• free 




n 



i» 




iMlneii of rlAJi|i and 



tmt P\^% Hj*Af» tn»***ng 



>«»■«> 



«l» 






KiRure 14. — Variouit nilMiiMffi i 
htinv. Iiilt«>r hiuh on linKtial nidi- nf t 
Shdwn vlfW«'(l from .hI(I«- and from 
innricix- A partlrvilarly fn-M-; ■• • 
two tiM'th, bl(M-klrik' (low i>' 
pyorrhfa. (d) ('l;i>p ufli-r 
(e) (*laMp on on** Mldt* only. , 
of bucrjil and linKuaJ It'nn. r- 
out. (Kl (Mai«p ;il)ov«' wld«'-.t .1 
WidcMt rroH.x .HrrtW>n tfiid-* ti» pn 

flow of saliva (fig I4('); clasps which do not allow for "setllinf" 
of a denture (I'ig 141)). and which, cutting into the gingi\al mar- 
gin after a short period of use. clasps without lingual su|>port. pwhing 
the teeth lingually (Fig 141'). clasps on teeth with lingual or buccal 
lean, pushing the teeth lingually or buccally on pressure of m^**- • 
tion (fig. 14f). clasps abo\e or below the widest cro*.* ^ 
pushing the denture or the tooth out respectively (Fig. I4G). all r^ 
Milt in a sequence of events tending toward the destruction of the 
tooth, attacking both the t(K)th itself and its \ery foundatn^n in iKe 
alveolar process In this connection it might be said that the \ulcantle 
clasp, carried around the gingival margin of the tooth. Kat no place 
in dentistry. Similar in action is the Jackson **cnb." |irimanly de- 
signed as a retainer in Dr. Jackson's system of remo\able octhndnnlia 
appliances, and l.ilei appropriated for proisthetic pur: ind useful 

it IS in certain mst.iiKes where a connection is desirei! mnkile o| 

a series of properly formed teeth without any cutting 

Adhk^ion. 

While ihr force of adhesion, of pnme importance m edentulous 
cases, is of secondary im|HHtance in {wirtiaU. yet. in certain <m%€^ 
in which its use w«nild relieve the few remAinmg tr^'*- • — *••' 
strain (I ig. 1')) its imptntaiue is considerable I h*- • 
method of securing imprensions in such a cate, mo«l 1<^- 

using Kerr's compound, trays avoiding the routcle coniraciKm. and 



106 



ORAL HEALTH 



if necessary, the sectional method, allowing the impression of all 
but the labial surfaces of the teeth to be returned to the mouth with 
softened edges for muscle trimming until the impression passes a test 
for adhesion by remaining in position while the patient makes dis- 
lodging movements, and the subsequent adjusting of a separate 
piece of compound representing the labial surface, and finally the 












pLMCti P/SLATH. COVH-I'^O 



Figure 15. — An instance in whiioh adhesion is used to relieve the strain on 
the anterior three teeth. This not being- necessary, skeleton construction 
might be used. (See Figures 20, C. 2, C. 3.) 

return of the impression to the mouth, covered with a thin mix of 
plaster, also with muscle movement adding to the result the accuracy 
of a plaster impression and drawing off any crowns, posts, copes, 
etc., in their exact relationship, will secure the highest degree of ad- 
hesion subsequent to compensation of the hard area mentioned later. 
In this connection, the study of impression methods for partial 
restorations would well fill a separate essay. 

Adhesion depends on molecular attraction between a film of 
saliva and the base on one side and this film and the mucous mem- 
brane on the other, held in this position by capillary attraction. 




-^ 





Figure' 16A. — In denture con- 
struction the lesson of above 
experiment is accurate, adapta- 
tion at periphery. As the base 
and the mucoisa tend to separ- 
ate, likewise the capillary film 
becomes lost, and with it ad- 
FiG. 183. — Water rises between the two hesion. 

plates of glass which touch along one 

edge. 

Figure 16.— Figure 183, from "Ontario High School Physics," showing the 
inoreasing- quality of the capilLary film as approximal surfaces approach one 
another. 



■■«■■■ 



OR AI HFlAl/f H 107 



Capillary attraction is lessened as the approx.mating uixfaccs 
separated (\'i\^. 16), therefore it is es(>ecially nrceuary in t^ 
higfi adhesion to preserve close contact at the \>ct ^ •voiamg. 

however, muscular contraction. It is patent also . .ue amounC 
of adhesion is in direct pro|)ortion. not only to the accuracy of the 
adaj)tation. hut also to the area of adaptation I f '•refoce the 
diininisliin^ importance of adhesion in small saddles. i He above- 
mentioned tcchiiKjue seems to the writer the most scientific mflhod 
of securing adhesion of maximum efficiency and in harmony %nlh 
physical laws. 




FiKuru 17. — (u; I iilfuttn di-n«Uy. (b) Hard «mi In r«ntr«. K-'***— •••»• 
denMlty. (c) Hard area in centre. Noft area on elthvr aUlv. ' ««■ 

deniiity. 

In I'Ximinatloii <.i niuiii loi hard and itofi > 
mouth tintl II IfiiU |M*n(*il bflnx rloM* nt hand, a rour 
'!>' in hand niiil itr.'iwn nrr" vault n 

it a tlnu* fr«»in rl«lK«' to ni> •.«•. In \ 

In encountered, in vault II the ln»trumrnt rllmtM up a h < t la 

centre. In vault C hard arvn In centre an*! -■'• "■— •■•• ^• 

tected. each noted on rni»t nn detected. 

iKUVrMKNT OK HaKD AkIA> 

In the median line is found in most up|>rr mouths the only ikwIioq 
of the mouth which it is said never changes, ■ " ' ^rdet tluin any 

other j)ortion of the mouth. In constructing . ih cover part 

of the soc.ilh-d haid .irea. cogni/ance *ht>iiUI he t.tkrn of tlw f^c^ 
that the central area is practically unchangeable while the baUncr 
IS to a small degree subject to change. Ilus may Ik* dune in iS^ 
case of a saddle covering all or considerable (xxtion ol the %auh by 
plotting out on ihr model. fr«>m a careful examination of the vmuh 
(I ig 17). the outline of the central hard area on the CAH •lid 
subseijuently reswaging the base (Ash pres^) u|»on a piece ol lolt 
lead from 16 to 24 gauge (depending on the .\ 

ence of density between the hard area anti thr • „r^ .%,... , 

(I*ig. 18 ) riiis at first results in a small re\e*« harn area 

upon which the base loses contact, and iherefiKe a '» w 

partly made up by the outside pressure on the ranfied air withm. and 
after "settling" is complete, contact in that area is I. with 

subsequent adhesion by contact with capillary him of sa...« 



108 



ORAL HEALTH 




(a) (b) 

Figure 18. — (a) Deutcher Differential Press of C. Ash and Sons, London. 
Note double leverage exerted on screw resulting in high pressure on block. 
(b) Showing reswaging process in section. The writer uses a steel tube cut 
from a solid cylinder of steel, with walls 5-8 inch thick, (A) instead of the 
cast iron cup provided with the press. The flask or oiled circular plate (H) in 
which the Spence Plaster Compound cast (F) is bedded (G). occupies the bot- 
tom of this. Next comes a sheet of thin lead (E), cut to the shape of the 
hard area (Fig. 17), next the base to be reswaged, then a sheet of rubber dam 
(By. then a quantity of finely divided rubber (B), over this the rubber block 
(hard) and steel pressure block. The use of finely divided rubber is a distinct 
advantage over the use of the rubber block alone, resulting in better adapta- 
tion at the periphery of the base to be reswaged, due to the more fluid-like 
characteristic of the divided rubber over the solid block. The swaging com- 
plete, the steel tube (A; and its contents can be moved off the press over a 
box or drawer, and the whole contents dropped through the bottom and re- 
covered. Should the box or drawer in which the finely divided rubber is kept 
be some little distance away, a piece of sheet metal should be used under the 
tube (A) enabling the tube and its contents to be carried without spilling. 
(See article in Review, August, 1914, Dr. H. Goslee.) 

(To be continued in April issne.) 



S.S.White Honor Roll 

THE following employees of the S. S. White Dental Mfg. Co., 
Toronto, have enlisted for overseas service: 

Keats, Louis, Sergeant 8th Canadian Mounted Rifles. 
Robertson, James, Corporal 2nd Division Cyclist Guides. 
Derrick, Reginald, Private 2nd Division Cyclist Guides. 
Harris, Kenneth M., Sergeant C.A.D.C. 

Thompson, Laurence E., Private 201st BattaHon Toronto Light 
Infantry. 



O K A I . H M A I. I H 109 

The Successful Practice of Denlutry* 

Wai.lack Skccombf.. D D.S.. Profeasor PRKVF.NTnx Dls- 

nsTTn AND Dkntal Economics. Royal College 

OF Df.ntal Surgeons. Toronto. 



THI'Kl. was never a time when more exacting demaock were 
made upon the denial surgeon than the present. Changci m 
the science and practice of dentistry arc to rapid that a prac* 
titionrr may hocomo old-fashioned in five years. Fifteen yean ago 
the younger members of the profession were universally considerecl 
more modern in their firaclice than were the older graduates. I"Kal 
time has passed. Advances have been so rapid that it is not now a 
question of being old or young, but whether you are abreast ol iKe 
times. I he advantage has gradually passed from the youOfCf 
graduate to the older man. who is familiar with the best thoufkl ol 
the profession and is able to bring his wider exfierience to bear upon 
modern methods of practice. 

I he standard of dental service is being continually raised \l\r 
dental graduate who leaves college to-day with the impressioQ that 
he can settle down comfortably to the practice of dentistry, dvpote 
of his college texts, ignore dental magazines and dental mectiBfik 
stamps himself, at the very outset, as a complete failure Ijkewn^. 
the older praclitionrr who has failed to study the later denial %rorkf 
and has thought himself too busy to attend dental conNentioQft is abo 
a failure He does not render that high quality of servKc which his 
years of experience would otherwise make |)oisible. 

Mrretofore. there have been those who have argued that the |>f ac 
tice of dentistry would never assume the im|>ortance of that of metn- 
( ine. because in the one case a tcxjlh was at stake and in the dhef a 
lifr The logic of that argument has l>een destroyed ihroufth the 
discoveries of science, that the presence of rheumatism, neuritis, endo- 
carditis, gastric ulcer, nephritis, and other svtrnrc Inion* .tre ch*e. m 
many cases, to local foci of infection about the roots of terlh. Row> 
now has established conclusi\ely the facts concerning the IrBIHmutl* 
lion of streptococci, the organism having, in one instance, an aftn4y 
for ihe joints; in another, for the ap|>endix. or in still another for the 
stomach 

I'or manv vears l\\r tlrnlal profession has rrcogni/ed the rrlalMO 
•hip belwrrn srpiic conditions m the inal cavity And manv trslemic 
diseases, but that knowledge has been based Ut^r 
experience Through the ol)serval?ons of Hunter ana vJmo. ana »nr 



•Rend U'furr Uindon l>rnUl S.« t^-l^ Ttth rv^t^rr 1»IS 
Il«»Hd bvforf Toronto |H*ntni 
Krnd bt^ritrr llnmllt<>n l>rnt 



no ORAL HEALTH 

experiments of Rosenow, Billings, Gilmer and others, the direct rela- 
tionship between local foci of infection in the oral cavity and systemic 
conditions of disease has been scientifically shown. The result 
is that leading members of the medical profession have come to regard 
dentistry as a most important factor in preventive medicine. 

Now what does all this mean? It means that the practice of den- 
tistry is a matter not of saving the teeth alone, but of preserving life 
and health. It means that much of the present practice of dentistry 
will be revolutionized. As a profession we shall have to adopt an 
entirely different attitude toward the question of the vitality of the 
teeth and the treatment of those roots that are comfortable and appar- 
ently healthy, and yet are maintaining a source of systemic infection. 
It means that the public will appreciate the importance of aseptic 
root canal work, and will, because of the vital issues at stake, demand 
that dental service be rendered in conformity with the most advanced 
methods of practice, and be more willing to pay adequately for that 
service. 

Now let us turn for a moment and ask ourselves the question: 
What is the successful practice of dentistry? The successful prac- 
tice of dentistry might be defined thus, the rendering of the best pos- 
sible service, under the most agreeable conditions, and the acquire- 
ment of fair remuneration for the service so rendered. 

When we speak of "rendering the best possible service*' we are 
dealing with a variable factor. The service rendered by one dentist 
may be a very different service to that rendered by another, though 
in each case the service may have been "the best possible." It is 
likewise true that circumstances may compel, in different patients, 
different treatment of similar conditions, and though the operator be 
the same, and though he may render the best possible service under 
ihe circumstances, the service rendered in each case may vary. 

Rendering service is, after all, the most important factor in suc- 
cessful practice. Unfortunately, skill and success are by no means 
synonymous, though a distinct relationship exists between them. 
Better dentistry makes for success, and success encourages better 
dentistry. 

There are many dentists, skilled in the science of dentistry, who 
fail entirely in the successful conduct of a dental practice. Upon the 
other hand there are those possessing only average skill, who apply 
correct principles in the management and control of practice, and 
who, therefore, meet with a fair measure of success. Every member 
of the profession should aim to be, not only a skilful dentist, but a 
successful dentist. 

The recognition of the successful dentist is much easier than his 
analysis. Under the microscope he proves a most elusive individual, 
and consequently we will approach our subject from the synthetic 
standpoint and study a few of the factors which make for success. 



ORAL HLAL I W ||| 



I o attempt any set formula would ht as fooluh as it ii 
Thoughtless imitation mu^t be avoided, for. after all. the 
success for any man is the highest and best pottible drvelopmcol ol 
himself. We are not. upon this occasion, so much concerned abool 
the creation of some fanciful character that we may rfrml.*!**. ^f %^ 
are anxious to study the fundamentals u|>on which ^ it buik. 

that we may, each in his own way, endeavor to apply these pfin* 
ciples to his individual problems and harmoni/e daily conduct %nlh 
those laws which govern successful practice. 

It is interesting to study the evolution of the dental prolcHioQft* 
attitudr toward this question. In the early days attention was 
focused upon the service to be rendered to the exclusion of almont 
every other consideration. Later the thought of the prolcMioQ was 
directed toward the rendering of the ser\ice under the most afjrccable 
conditions. I his naturally led to the study and use of e\ery approved 
means for the relief of pain, the acquirement of the best dental equip- 
ment, and the adoption of well ap(>ointed and pleasant oike 
5urroundings. 

I he third re(]uisite is ecjually essential to successful practice. 
namely, the acquirement of a fair equivalent for the service rendered. 
An equivalent to he fair must be intelligently fixed Ma|iKa/ard 
methods in this important matter works nothing but ir to both 

patient and operator. It is simply a (jue^tion of eqwu.- .its To 
lender a service without proper remuneration is unfair to the 0|>eralar. 
To secure a fee without rendering the best |)ossible service is equafly 
unfair to the patient. In either case an element of dishonesty enters 
and failure results. Unless economic law o|>erales successful prac- 
tice is impossible. 

Gknf-Ral Offic k Masac;k.mknt 

One of the most common mistakes is to make loo many appoisl- 
ments during the day. Many men cling to the half-hour a|)poial- 
menl plan instead of adopting the hour basis for In 

place of fourteen patients in the day. th- ^\ <Mua 

receive one half that number. Ilie rei •- , t \ ^^l 

of wraps, sterilization of instruments, adjustment < ! •. 

preparations of operator, obtaining history of caw sirKe last treat- 
ment, the preparation of the operating room for ne\t |vAtimt. w<h 
the few passing words of greeting and farewell, ih^t the arduiary 
amenilies of life demand. c«>n5ume. at the lowrU r^limation. U\r 
minutes at either end of each silting llus means ten minu«n for 
each patient, and if ap|>ointments are made for se^en morr {lalicals 
than are nece^ary, the total Iom of time each ^^ < i , seventy 

minutes This, in effect, is just the dif^*-"-' • • i*in« the 

office at five o'chx-k rather than ten mim ^t si*. 

Furthermore, the half hour apfwinlmenl plan makes * al 
impossible to overtake the schedule. follo>%-ing any unairoidable d 



112 ORAL HEALTH 

This usually results in a number of patients waiting in the reception 
room, and this, in turn, diverts the attention and interest of the 
operator from the work in hand. His mind attempts a solution of the 
problem of how to get these three or four patients out of the office 
in the least possible time, but before he accomplishes his design yet 
another patient may arrive, and so the process continues, with loss 
of time amounting to many hours in the aggregate, and no single case 
appreciably advanced toward completion. This, in a word, tells the 
story of a simple inlay restoration, taking six sittings to complete, 
extending over a period of six weeks of time and a fee of six dollars. 
Result — waste of patients' time, and a direct financial loss to the 
dentist, who cannot honestly charge more than the service would have 
entailed if carried to a conclusion in the most expeditious way. The 
habitually crowded reception room indicates a lack of good man- 
agement and is all too prevalent. In dental offices where the most 
work is accomplished there is no sign of crowd, rush or hurry. These 
symptoms manifest themselves in the offices where gross receipts are 
correspondingly low. 

A fixed consultation hour from four to five is a decided advantage, 
being available for examinations, short treatments and consultations. 
A fee should, of course, be charged for consultation in those cases 
where the treatment is not proceeded with. 

Another important consideration is the proper and sufficient ven- 
tilation of the office and the maintenance of the atmosphere at a fixed 
temperature. This point should be that degree of heat which will 
enable the operator to work at his highest point of efficiency. This 
will be found to be many degrees lower than that which prevails in 
the average office. Thermometers are cheap. Place one in each 
room and make it the duty of your assistant to see that plenty of 
fresh air enters and a fixed temperature is maintained. This degree 
may be too low to keep certain patients comfortable, but in such 
case^ the use of a steamer rug, thrown over the patient, will overcome 
this difficulty. Fresh air in the office will not only increase and 
improve output of service, but is also a decided factor in the main- 
tenance of the dentist's greatest asset, namely, good health. 

Preventive Dentistry. 
In rendering the best possible service we must practise all that is 
known of prevention. The dental profession is constantly urging the 
claims of oral hygiene as a health measure, and in the profession's 
public oral hygiene propaganda, prevention plays a very important 
part. Does the average dentist practise personal oral hygiene? 
What would an examination of the mouths of the dentists in this 
room disclose? Do we practise oral prophylaxis for our patients, or 
just clean those surfaces of the teeth that are practically immune and 
that the patient can see? Does orophylaxis mean to us the polishing 
of those surfaces of the teeth that are most susceptible to caries? 



ORAL HKAl/IH 113 

Are wr in rarnrst ? Do wc really practise wKal we preach in ref ard 
to prevention? 

No crown, hridge or other restoration should be jHJt in place unlU 
the p.iturit has accjuired the habit of proi>er daily care of the mouth. 
How much greater will be public respect for denlnlry when palimU 
are told that a crown or bridge or other restoralton %*nll noC be 
inserted until sufficient knowledge has been acquired by the paticnl 
to intelligently cleanse the mouth and sufficient interest ftho%ni to 
perform that duty with regularity 

A system designed for the periodic notification of patients to return 
for dental examination is essential to the effective {>ractttc ol pre- 
ventive measures. I he plan usually followed is for the o^e AMiglanI 
to fix an ap|)ointment when the pre-arranged dale i« reached. An 
ap|)ointment card is then issued and sent to the patient with an . 
mation. somewhat as follows: 



7 /?c enclosed appointment has been 

made in compliance with \four re 

quest for ref^itlar dental examination 

and treatment. 



Only patients who clearly understand the moti\e prom|>(mc tuch 
a plan should he included in this service, and only then at the fptcifcr 

re(juest of the patient. 

Painllss Dentistry. 

No dentist can honestly promise to render painless wrvKe. and ^^ 
it is important that every operator should cause the minimum of \^ 
Painless dentistry, in so far as that may be poiiible. hat a decided 
economic value. It is the judgment of the writer that fifty j>et cent ol 
the pain and discomfiture of our patients at the (Kcsent tilDC couid 
be eliminated by the use of sharp instrument, a true-runnoit dt©lal 
engine, sharp burs and abrasive stones that don't wobble 

Annual Ukuce Budget. 

At the beginning of each year an office budfct thould be pre- 
pared covering fixed charges, overhead cx|>ente« Alld All mmOTf 
items, including the salary to be drawn by the i>$H-f atof. Ffow fhm 
budget an average hourly fee may be struck foe the year 

This budget should be prepared at least oner a year. « - • Hme 
in the interval when the overhead charges of the other a,, ■ iably 
increase or decrease, a*, for instance, in case of 

Increased or decreased rent. 

Increased or decreased salaries of a-Mtant oc lalniral^w^ help. 

Increased or decreased salary of c\cu\M governed by 



114 ORAL HEALTH 

(a) Demand for services; 

(b) Speed, skill, experience; 

(c) Cost of living. 

Thus the dental fee is automatically adjusted to conform to econo- 
mic law. As an operator becomes older and works less rapidly, or 
there is a diminution in the demand for his services or a decrease in 
the cost of living or in office expenses, the average fee would be 
reduced, and conversely, as an operator increased the service rend- 
ered in a given time through increased skill, experience or speed, or 
the cost of living or office expenses increased, the average fee would 
automatically increase. 

This budget for the average dental practice in an Ontario city 
would work out about as follows: 

Capital Account — 

College expenses per session $450 00 

Value of student's time 500 00 

950 X 4 $3,800 00 

Equipment of office 1 ,200 00 

$5,000 00 

Overhead Expenses — 

Yo on Capital invested $ 300 00 



Depreciation on equipment, 10% 120 00 

Rent and heat 300 00 

Janitor service 60 00 

Light, gas, power 20 00 

Telephone 50 00 

Laundry 30 00 

Taxes 25 00 

Sundry donations 50 00 

Office assistant 350 00 

Dental supplies and laboratory 750 00 

Insurance — Sick, Accident, Fire Insurance ($1 ,200) | \A^ 0() 

Life Insurance ($3,800) ^ 

Salary — Savings for Investment $ 500 00 

Wife 1,000 00 

Self 1 ,000 00 

2,500 00 

$4,600 00 

Hours in Office — 

7 hours per day; 

5!/2 days per week — 38!/2 hours; 

For 45 weeks (7 out) — 1,732 hours. 



ORAL HLAL 1 H 115 

Of this number not more than 60'' of the hour« are actual pro- 
ducing hours, or say approximately I .(XK) houri. 

The average hourly charge, therefore, m ihii ca»« would b« V4 60. 
and it would he with this average in mmd that this parttculax denliit 
should fix his fee. 

It must be clearly understood that this average fee it merely a 
guide. Were it applied indiscriminately in every case, or for every 
hour, it would be just as illogical, just as unfair, and jusi ai absurd 
as the old fashioned system of charging a flat rale for certain opera- 
tions (or should we say articles?) 

This fee should be raised or lowered as conditioos vary. l\%e 
following factors should be considered: 

(a) Knergy consumed (nervous patient or child); 

(b) C haracter of service, exceptional skill. 

(c) Speed of operator, amount accomplished; 

(d) Patient's ability to pay; 

(e) Cost of laboratory service. 

I bus we have a logical and intelligent fixing of an average fee at 
a guide or standard, and a constant variation of that standard to 
meet the circumstances of each indiNidual case 

How utterly unfair and unprofessional is the old plan of ^•i"^ 
fees upon the number of fillings inserted, the number of crowns, or ihe 
number of teeth comprising a denture or bridge. One has only lo 
compare an economic basis of fixing the dmtal for with the older 
system to appreciate the financial, ethical and profc«MOoal \alue of 
the more modern method. 

I^ach dentist should prepare his own budget and thus arrive ml'-''; 
gently at the proper fee. Ilie fixing of a minimum fee for the pii> 
fession ^en(>rally should be c.irefully a\oided A flat mtfUBMOl 
thargj- would work an injustice to both p.itimt .%nd operator. AM 
be of little .idvantage over past methods 

I^HOKAIOKV C OM 

It) tin- foregoing budget laboratory service is irKluded at a refuUr 
overhead expense, and in fixing the fee for any given period allow- 
nnce must therefore be made according as ihrre has been more or 
less laboratory service involved. 

In many ways it is preferable lo exclude lal>oratory service fwm 
the budget (which in the case ciled would reduce the average Hourly 
fee lo a litlh- less than four dollars) and ihen in each case add a 
fuffirient to cover the laboratory charge Ilii* method will be U 
parlicularlv c(Mivenienl ior those who ha\r iheu laboratory 
done outside ihr ofhce 

C*Ko?v5 AND Nrr. 

Professional men fretjuenlly deceive ihcmsrlvef by ' .: ol the 

volume of practice in gross, rather than in net Many denhrts are 



116 ORAL HEALTH 

ever ready to tell what their gross practice is, but are significantly 
silent upon the matter of net. Let us remember that the important 
economic consideration is not that of gross receipts, but the net differ- 
ence between receipts and expenditures. 

The particular budget above referred to showed a relationship 
between gross receipts and net profit, as follows: 

Total receipts $4,600 00 

Expenses 2,100 00 

Net (salary) $2,500 00 

That is to say, in every $10.00 received, $4.60 represented ex- 
pense and $5.40 profit, or in other words the cost of conducting the 
office was 467^- Statistics gathered from many different sources 
mdicate that it actually costs an amount varying from 40% to 60% 
of gross receipts to conduct the average dental practice. 
Making Contract With Patient. 

In all cases where dental service is being sought by a new patient, 
or where some special or extensive service is being rendered an old 
patient, it is advisable to decide upon an approximate fee for the 
completed case, and then have a clear understanding with the patient 
regarding the fee before commencing treatment. The following con- 
siderations are of value: 

First, — Case should always be given adequate study before treat- 
ment is undertaken. In making this study one must take into account 
the patient's financial ability, and then the best possible treatment or 
restoration under the circumstances should be advocated. Complete 
study does not mean making an immediate diagnosis and rendering 
a snap judgment upon what may appear, at the moment, to be the 
most advisable method of procedure. Models of the case should be 
prepared and sufficient time taken in the interval between the first 
and second sittings to give adequate consideration to all of the ques- 
tions involved. 

Second, — A careful estimation of the service to be rendered and 
the approximate fee determined. In this connection one should con- 
sider the possible time and energy to be consumed, the skill required, 
and the amount of expense involved. 

Third, — Making contract with the patient. Having decided upon 
the best service to be rendered under the conditions present, and the 
approximate cost of the same, the matter should then be presented to 
the patient in such a way as to secure the patient's attention, interest, 
desire to obtain, and finally, decision to have. 

Always treat the patient's mouth as a single case. It is essential 
in the study of the case and in all discussions with the patient to treat 
the mouth as a whole, and not from the standpoint of a number of 
separate operations. Improper occlusion, faulty contact or imperfect 
dental restorations, previously inserted, should be corrected, and the 



ORAI HtALIH 117 

entire mouth left in a condition of health and as ncafly oonnAl m 
possible If we beHcvc what wc leach and preach re^ardrnf oral 
hygiene, wc do the patient an injury by leaving in the mouth faulty 
operations, imperfect occlusion or contacts, jusi because lKe»c condi- 
tions don't happen to be causing acute trouble. 

So long as we charge for crowns, bridges, oc filling*, the paticnl 
will place dentistry on much the same plane as the purchase ol 
optical supplies or other merchandise. We must show ihe (vatienl 
the relationship between normal restoration and the m - ' -- ol 

a liygiemc condition in the mouth, and further, the rr.-ii. f*- 

Iween oral health and good general health. It is only as \-. 
the patient to the value of the service rendered that the |>atienl will 
fully co-operate in the work, appreciate the dentisl's efforts, and 
gladly pay a fair remuneration. Under such condjtiofis the pAtMOl 
will not look upon tlie dentist as practising a refined form of r ob b ery. 
but will rather look upon the dental operator as a real friend and 
Ixriefactor. 

Generally speaking, we must make health and ap|>earance two 
strong points in our presentation of the case to the patient; heahh 
particularly in the case of men. and appearance in the case of women 

Don't talk mechanics, don't talk gold or porcelain Such pro- 
cedure is precisely akin to a surgeon discussing the kind of hgaturr 
he is to use in an operation. We should use the material mdicaird 
and the best of its kind m each case Vie may take for grant*-* '* *' 
the patient has ccjiilidence in us and exj>ecls us to use as an a 
to our personal service that material, be it gold. siUer, or cement that 
will best accomplish the desired result By discussing these 
in (h-tail we but focus the attention of the patient ujhmi iuaI 
r.illier than upon the service rendered lliis \ci\ thing, he 
been done so fre(|uently that the public has come to look upon the 
materials used as more im|K3rtanl than the *kill demantJrd in thew 
manipulation. In fact, dentists have l>een known to t ' c*"'v 

for a tiown and throw in the treatment and hlling of t... ..-.-; .i— - 
lutely without charge Howe\er. according to Dr C*ilmcf. 
in some of these cases the patient may ha\e |»atd all the In 
was worth. Hie treatment of the roots of teeth has Assumed a pow 
tion of growing impoitance. and wr mu*l na< only rOKxr Mttcf trt 
vice in this regard, but secure an adr»|uale fee N^ e muil <Op tHIiBf 
gold and capilali/e our skill HnaiMc gold » no« used w ihr fjprta 
lion of prophylaxis, this. loo. one of the mort im|wrtanl |Wt^ 
in dental practice, is either not charged for at all. or ihr fee h\ ! a- 
a ridiculously low point 

II HM5 OK PAVMrST 

Not only should we. under the conditioiis above "xl. <birut« 

frankly with the patienl ihe approximate fee. but also IH€ 



118 ORAL HEALTH 

payment. Make such a definite, decided arrangement that the ques- 
tion will not have to be re-introduced at a subsequent sitting. 

Regularly, there should be a retainer fee of from 25% to 50% of 
the total contract and the balance upon completion of the work. 
Where a business man cannot meet these conditions he will gladly 
give promissory notes in convenient amounts, maturing at convenient 
dates, and covering the balance due. In most cases, however, where 
the patient cannot pay cash, the matter is best arranged by estimating 
the number of sittings to complete the work, and then have the 
patient pay a sufficient sum each sitting to make the completion of 
the operation and the completion of the payments approximately 
coincide. Where it is more convenient to the patient, a fixed weekly 
or monthly payment may be arranged. These arrangements having 
once been made, the office assistant will best be able to see that they 
are carried out. 

Some dentists render accounts monthly and others upon the com- 
pletion of the work. In every case it is advisable to have printed on 
the statement that accounts are due upon completion of operation. 
This makes the account overdue no matter when rendered. 

Competence. 

Every dentist should look forward to retiring after from twenty- 
five to thirty-five years of active practice, with sufficient capital set 
aside for a competence for his remaining years. The only way for 
a professional man to accomplish this is to deliberately plan to save 
a fixed sum each year and invest the amount in endowment or 
twenty pay life insurance, or in good securities, real estate or bonds. 
A man should save sufficient, that when the period of retirement 
arrives, his income will practically equal what he has been receiving 
from his practice. The following estimation is only approximate, but 
gives a fairly accurate idea of what the annual saving should be: 

$500 invested annually at 6% compound interest will 

amount in 35 years to $50,000 00 

$500 invested annually at 6% compound interest will 

amount in 30 years to 35,000 00 

$500 invested annually at 6% compound interest will 

amount in 25 years to 30,000 00 

Dental Standards. 
The very foundation of successful dental practice is that the oper- 
ator shall have in mind a clear picture of the normal, natural den- 
ture. The mouth should be studied from every standpoint, and the 
relationship of the surrounding parts kept clearly in mind. The im- 
portance of the dental arches, from the standpoint of facial expres- 
sion, the nasal passages, the throat, speech, occlusion, oral cleanli- 
ness and general health should be carefully studied. This picture of 



OK A I. HKAl. I H 119 

the normal, natural drnturr should ht so clear to us thai we aic ooC 
only able to compare with the normal each case that procnU, but 
arc also able to convey this picture to the mind of the {>atient. 

As the public more fully reali/es that the practise ot dentistry ts 
the cure of disease and the practise of normal restoration, there %nU 
be markedly increased appreciation of the value oi dental service. 

The Growth of the Canadian Army Dental Corps. 
Cap IAIN W. G. Irelford. Toronto 



THE C.A.D.C.. the "baby" organization of the Canadian 
Militia, although still in its infancy, is recogni/ed to be ind»- 
pensable. It has proved beyond contention its advantages as a 
separate unit. 

I he ^status of the army dental surgeon has advanced from honof • 
ary rank under the directorship of the A.M.C. to that of a dirtiDCt 
or(;ani/ation. Instead of honorary we now have substantive rank, we 
have staff representation, our own research officer, and our head 
known as the D.G.DS (Director General of Dental Ser\u'-0 

In l'H)4 the first dental surgeon was ap|x>inted to the C . .a 

Militia He held the rank of honorary lieutenant, and after b%e 
years' service was automaticallv ranked as honorary captain undef 
the A M.C 

In those days little was heard of the army dental sunteon: lh» 
episode will illustrate: 

W I I lackett. the first dental surgeon Ap|>oinled to the Cana 
dian Militi.i. was stop|)ed at Niagara Camp and aiked what the 
"D.S * on Ins shoulder straps stood for He prom(>lly replied for 
"Distinguished Service, Sir." unconsciously s|>caking a great truth 

I he only equipment allowed at that time was a head rest. %rhicii 
was attached to an ordinary chair: the small sum of $10 00 was sH 
aside for supplies and the officer furnished hi» own inUruOMBlt; OO 
attempt w<is nuide at prosthetic work letter a «mall l#Attlfr CAST 
was supplied, with a few instruments, including foccrp*. pliet* and 
mouth mirror 

It was very .ipparent at thn time the nete^^itv ol A Ulial admuu»* 
tered bv dental officers if the hiKhest efli« • • ^f the artny wa« to be 
reali/rti (.ijirady the Ciermans had rec«',. 1 the nerd. ar>d •rtrfal 

military volumes of considerable tt2e dealing with dentiUrv in the 
army had been issued) 

In the early days of the war so m.\ ruit% \*rfe rr^cvted as 

medually unfit on account of the oral % ....un eustinfr '*^«' * '»*^ 

problem faced the military authorities. 

1 he dentists were aiding in e\ery way pOMible. both HsdivKkiAlljr 
and collectivelv. and civilian clinics were establtshrd tl 



120 ORAL HEALTH 

Canada. In Toronto alone there were six chairs in operation in the 
fall and winter of 1914 at Exhibition Camp, but these could not 
cope with the work, and there was the added problem of caring for 
the troops overseas. 

In May, 1915, was born the C.A.D.C, under the leadership of 
Lt.-Col. Armstrong, and almost immediately fifty officers were ap- 
pointed and sent overseas, accompanied by Col. Armstrong, to organ- 
ize and carry out the services in England and France. 

Up until August 11, 1915, no recruits were accepted who wore 
artificial dentures, partial or full; thus we were not allowed to prac- 
tise dentistry in all its branches, and not until August 30 was the 
necessary authority forthcoming to proceed with the prosthetic end 
of the work, although there was an overwhelming demand. 

The services of the C.A.D.C. extend from Hahfax to Vancouver, 
cover England and France, and extend as far east as Egypt and 
Greece; in fact, so well known have the services become, and so 
high a standard has been maintained, that they have been com- 
manded, and quite recently, by the Royal Family. 

To secure an appointment with the C.A.D.C. an applicant must 
be a graduate of a Canadian college or a licentiate of a province of 
Canada. He must be approved by the O.C. of the C.A.D.C, as 
well as recommended by the G.O.C. of the Division in which he 
applies. This recommendation is then forwarded to Ottawa. On 
being appointed he is given the substantive rank of lieutenant, and 
on proceeding overseas is ranked as captain. 

An officer is allowed an orderly, ranked as sergeant, who must be 
a qualified mechanical dentist, and a batman, ranked as a private. 

Canada is divided for military purposes into thirteen divisions or 
districts, of which there are three in Ontario. 

For Division No. 2, on June 16th, 1915, under the very able 
supervision of Capt. Guy G. Hume (then Lieut.) the first dental 
services were inaugurated at Niagara Camp, in the same building as 
was held the first Parliament of Upper Canada, under Lieutenant- 
Governor Simcoe in 1 792 — the old historic Navy Hall. 

This camp quartered 1 0,000 troops, yet Capt. Hume was allowed 
the assistance of only one officer until July 10th, when authority was 
granted to employ an additional officer, and four civilian dentists 
(the latter were provided with transportation and subsistence). 

The basis on which dental appointments are now made, is one 
officer for every thousand men recruited. 

There are now in No. 2 Division some twenty-five chairs in opera- 
tion, eleven of which are located at Toronto, ten at Exhibition Camp, 
and one at the Military Convalescent Home. All convalescents are 
cared for. 

There are also clinics in operation at North Bay, Sault Ste. Marie, 
Owen Sound, Barrie, Orillia, Uxbridge, Oshawa, Brantford, Wei- 



ORAI MKAL I H 121 

land. Brampton. Hamilton (three chain), and arrangcmcalB bftvc 
been i)ractically completed for cimics at other placei in iKit rfcrkinn 
This arrangement is carried out m much the tame way in other divi- 
sions throughout Canada. 

I he 1 oronto clinic is c(]uip|)ed with the latest type ol ncxtiK 
dental engines, good chairs, fountain cuspidon. and other ■p^w^f 
equipment which tends toward efficiency. Much thanks is due Gen- 
eral Logie. the G.O.C. 2nd I^ivision. who. along with Capt. Hume. 
was instrumental in securing this fine erjuipment. 

It might bo interesting to note the volume of work accomplnhed M 
this division, which is comparatively small when you consider the 
scope of the C.A.D.C. Iliis report is given up to the end ol Febru- 
ary: 

Prophylaxis 460 

Kxtraclions 19.333 

I reatments 6.285 

Fillings . 14.575 

Finished cases ... 4.853 

Dentures inserted 1.242 

General anaesthetics 60 

Fmergency cases 2.076 

Patients seen 12.782 

Number of operations 43,205 

Some restorations have been made in gold — in case ol coQva> 
Icscents. 

A new establishment, which has been drawn up by Major CUy* 
ton. Deputy DG.D.S.. of Militia He«Adquarters. Ottawa, pro- 
posed, and part of which is authorized, will l>e a great step lorward 
in our ranking. 



D(^ntal Operations Performed l)y Oflicrn of the Canadian 

Army Dental Corps in I\n^l.\nil arul Ovrrs^ai, 

July I 5th to Dec. >lst. P)I3. 

Headcjuarters. C.A.D.C,, 23 \jktU /\\r . 

Folkestone. Frinuary 1 5th, 1916 

Month. KillinK* r . »• - t • 

•July. 15 ofWcrn* 1 <>^». -'.:•• 

AUKiiHt. 31 ortltHiii ft.Kil 7*7 

.»<ri»tt'inbrr. 3S omort - 7.180 I.SOT 

()c<nb4nr. 43 i^mrrni t.tfO l.fOl 

Novrnihiir. 4S offlrrrii . 10.7M S.ill i 

tlVrrmbrr. SH .>mrf»r« «.»ST l.fM I > 

Totwln «t ' ^09 \ 

♦Dental clinics were not o|>ened until the 13th July, wuh t%»Tite 



122 ORAL HEALTH 

outfits, and eight more were received on the 22nd July, which gives 
an average of fifteen officers for the latter half of July. 

t Reports have not yet been received from four officers. 

Note. — The total number of operations is 101,474; the average 
number of dental officers for the five and one-half months is thirty- 
seven; the average number of operations performed each month by 
each officer is approximately 525. 

On September 4th, 1915, the seven dental outfits used by the 
officers of the 4th, 5th and 6th Infantry Brigades, and the 4th Bri- 
gade, C.F.A., were delivered to headquarters, 2nd Canadian Divi- 
sion, for shipment overseas. They were not returned to the dental 
officers until September 27th. The only dental operations performed 
during this period by these officers were extractions and treatments. 

J. Alex. Armstrong, Lt. -Colonel, 

Director of Dental Services, 

Canadian Contingents. 



Canadian Dental Association. 

THE 1916 meeting of the Canadian Dental Association will be 
held in Montreal, September 1 2th, 1 3th, 1 4th and 1 5th. This 
ought to be a great "get-together" convention, attended by den- 
tists from coast to coast. Reserve the dates. Reduced railway fares. 
Full convention announcements later. 



Ontario Dental Convention. 
Toronto, May 8th, 9th and 10th, 1916. 

DR. ELMER S. BEST, Minneapolis, Minn., will give a paper 
on "Treatment and Filling of Root Canals**; other important 
features will be: 
Treatment of Pyorrhea by General Practitioner. 
How to Make a Diagnosis. 
Use of Elevators in Exodontia. 
Surgical Treatment of Apical Infection. 
Cementation of Inlays, Crowns and Bridges. 
Impression-taking. 

Good clinics. Usual reduced railroad rates. Mark these dates 
now. Fuller announcement later. W. T. B. Amy, chairman. 



Toronto Dental Society. 

THE officers of the Toronto Dental Society: Past President, 
Dr. F. C. Husband; President, Dr. E. F. Arnold; First Vice- 
President, Dr. W. B. T. Amy; Second Vice-President, Dr. 
J. E. Rhind; Treasurer, Dr. W. T. Dawson; Secretary, Dr. R. D. 
Thornton; Auditors, Dr. E. C. Abbott and Dr. W. E. Willmott. 



Letters to Oral Health frc m Membcis of the 
Canadian Army Dental Corp*. 

LiLUT.-COL J Al.i iRONC. 

Hcadcjuartcri C.A.D.C., 23 EmxU Ave., 

F'olkstone. February 21. 1916 

lo Dr. W. Scccombr. 

269 College blrccl. 
I oronto. 
Dear Doctor Scccombc. I wish to thank you for mytrlf and oa 
behalf of the Canadian Army Dental Corp* overseas for your 
ihou^htfuiness in sending copies of Okal Hfjvi.TH. which arrmd A 
few days ago. and have been received with many inir f inni ol 
appreciation. 

I he corps here is gradually winning its way to recognition and 
matters are sha|)ing very well at present, though more ofBcers arc 
needed to carry on the volume of work presenting itself at all our 
clinics. 

Our clinics and laboratories are the busiest to be found anywhere. 
and all are working with a will. 

If Major Smith c <u) find time 1 will have him send you A report ol 
our work up to Dec. 31, also any other items of intereiC for your 
readers. 

Sincerely yours. 

J. Ai.KX. Armstrong. Ij.-CoI. 
Director of Dental fWrvicet 

¥ ¥ « « 

Major A. A Smith. 

Headquarters C.A DC . 21 Farb Ave.. 

Folkstone. I rbruary 21. I9l6t 
Dr W. Seccombe, 

OivM Hl.Al.TH. 

i.)r.ii >ir. 1 .im taking the lihertv of * i « nuoUlfr ol 

corrections for your .Active Srr\ice Koll. a^ , i your jaBuarjr 

number of Okai. Hkai.TH. and which I am sure you w\\\ be glad to 
have, as they are .ibsolutely correct so far at the overicat brt ii 
concerned. 

! believe there are a good many motr on the list ol ofccn cm 
home service than appears in tin* mimbrr. but the names imiil be 
cibtnined from Ottawa 

I want to give you some idea of the work I 
figures are a\ailable. before long, a* I ferl * 

your eyes. |nr instance, in the month oi ftn , , > .- tu:nrv! 

out from St Martins' Plains lalnuator) a », Of •■ 

average of 140 a week, and we have four laboratnne* worl 



124 ORAL HEALTH 

The operations in the clinics average about 40,000 a month, so you 
see the C.A.D.C. are not loafing on this end of the service. 

We need more operators here badly, as there are none here but 
those w^ho came over w^ith me in December, and we have 50,000 
troops scattered about, and more arriving every day. 

Applications arrive every day or so for dental officers in hospitals 
or brigades, but we have reached our limit until reinforcements arrive. 

Seven officers went to France in January, and we have had to 
shift our operators about to repair the vacancies and keep the clinics 
going at full speed. 

Now I must not take any more of your time nor of my own, for 
I have not yet solved the problem of getting two things done in the 
time it takes for one, and consequently I am busy. 

Sincerely yours, 

A. A. Smith, Major. 

rp 9^ ffi f^ 

Capt. Oliver Leslie. 

Hythe, England, February 20, 1916. 

My Dear Doctor Seccombe, — Just a few lines to thank you for 
Oral Health, which you are so kindly remembering us with, and 
which I always enjoy. I think we devour the Canadian publications 
with a deeper appreciation and a keener interest than we were wont 
to do at home, due no doubt to the fact that here we are strangers 
in a land that is strange — if not sympathetically, at least geographi- 
cally. 

Since our landing in England last July the members of the Cana- 
dian Army Dental Corps have become widely scattered, many being 
absorbed by the various hospitals and camps in southern England; 
many in France, and a small minority between Salonika and Egypt. 

My first six months I spent in charge of the dental clinic at Moore 
Barracks Hospital, Shorncliffe, where your townsman. Col. Scott, is 
officer commanding. Here we had a sick parade daily, averaging 
fifty men, and daily we turned out about ten artificial dentures along 
with our other dentistry. Some of the patients were from the hos- 
pital, some from local camps. In the case of soldiers from the front, 
presenting fractured jaws and shrapnel wounds of the face, the work 
was most interesting, as were also their vivid details of the fighting 
at Ypres and Festubert and Givenchy. 

However, I was well pleased when, about three weeks ago, I 
received my appointment as dental officer to the First Pioneer Bat- 
talion, then in barracks at Hounslow, which is only a forty-minute 
run by tube from London. They tell me that as far back as Roman 
days this heath was used as a military camp. The barracks now 
standing were built during the Boer war. From the aerodrome, close 
by my hut, I watched many a flight of our aircraft as they circled 
over the Parke-Davis factory and disappeared into the blue. 



OK A I. HEALTH 125 



Wc had barely gotten our clinic in good running orcict here 
the battalion was ordered to Hythe for muikctry i^actice. aod «/e 
now in tents on Dibgate Plain. Fortunately for me. I am tempor- 
arily "carrying on" in my old quarters at Moore Banacks. wbcre 
Captain Wright, of Calgary, is now in charge, and whwe I mm 
trying to get all the plate work that my battalion requires coQi|>l«fed 
before wc cross to France, where I may be reduced to the exigcocici 
of war: a tent for a clinic, possibly with corresponding irKonvemeoccik. 

It was with deep regret and a sense of grrat |)«rK>nal loti thai I 
learned of the death of my old classmate. Major Sale. I had the 
{)leasure of dining with him at the mess at West Sandling when the 
16th battalion were camped there last August, and many were the 
leminisccncrs we exchanged of our good old days at the K C D S. 
together. He was just the same: high-spirited. jo\ial and extremely 
popular with everyone who knew him. as of old. 

Hythe is a very interesting old town, one of the Cinque (>ortt. arid 
the eastern terminus of a canal f)uilt (as were also the Martello 
towers that dot the coast line from Dover to Hastings) lo rcpd ikc 
expected invasion by Napoleon. At \ iythe. too. is a famoui ttliool 
of musketry, where as many as seven hundred men may practise at 
once. Ilic window in my billet looks out across the downs, wKefC 
hundreds of fat SoullKlf)wn sheep are gra/ing. and to the eM%t arc 
the hills and ha/ards of the Hythe golf links, where I had many a 
lound with M.ijor Perry Goldsmith before his return lo 1 oroolo in 
January. I he links are most picturesquely situated, looking out o%ef 
the restless channel, the red tile roofs of the little town huddled to- 
gether towards the southwest, and westwardly the grey lo%refs ol 
Sallwood ( astlc. while on the east one glimpses \arious cmmt^ i\\r 
tents of Dibgale Plain and the huts of M(x>re and Napier 1 
with a northern horizon of rolling hills and blue sky \ i<^^* tety 
different will be the outlook next week when, with the Fir *' 
I am in the devastated country across the channel > 

\\ ilh very many thanks to you. I am. 

Fraternally yours. 

OtIMJt iXSUC 



Mire [^entNt5 Wanted at I he Ironl. 

DK C. N Kl '."^.^l .1 .1 .. profeMOf of orAl surgery at 
I niversity. \slio retenlly returned from the front, italrd to A 
newspaper correspondent that 50 |>er cent of the wottMlfd 
soldiers re(juire dental treatment, and consequently tKete m a fTfttl 
shortage of dentists. 

"One p(K)r fellow came into the American Hosfi^al iiiMMHy 
wounded." said fVofejw r Ku^*ell in citing a case wHidi he Hated 
was typical of many. "His entire lower )aw. wnh the eu«|4wn ol 
two fragments on each side, was snot away 



126 ORAL HEALTH 

**The dentists, by attaching a mechanical device to his head, man- 
aged to hold the fragments of jaw in place, and the surgeons actually 
made a new jaw with plaster. 

"Then the dentists replaced lost teeth and the soldier was again 
ready for duty. 

"In trench fighting more than half the men are hit in the head, 
but owing to the shortage of dentists many of the men are compelled 
to wait a month for treatment. The French and Italians have 
realized the importance of the dentist, and have provided a dental 
corps for every field hospital." 



College of Dental Surgeors of Quebec. 
Donation to C. A. D. C. 

FOLLOWING an address by Major Clayton at Montreal, the 
Board of Governors of the College of Dental Surgeons of the 
Province of Quebec donated $250.00 to the Canadian Army 
Dental Corps. The following letter accompanied the donation: 

Montreal, February 21, 1916. 
Major Clayton, 

Commander Canadian Army Dental Corps, 

Ottawa. 
Dear Sir, — I take great pleasure in sending you the enclosed 
cheque for two hundred and fifty dollars ($250.00), subscription of 
the College of Dental Surgeons of the Province of Quebec towards 
the welfare of our boys at the front. It is desired that you should 
use your own judgment in the disposal of this money, as our Board 
of Governors hold the unanimous opinion that you are the right man 
at the right place, and are willing to back, to the ultimate Hmit, your 
valorous efforts to make the Dental Army Corps worthy of the cause 
they are fighting for, and the army they are working with. 

Yours truly, 
(Signed) JoSEPH NOLIN, D D.S., 

President. 



Commendation for Dental Services at University Base 
Hospital, Salonika, Greece. 

IN a recent communication, Surgeon-General J. A. Roberts, in 
charge of the No. 4 University Base Hospital, referred to the 
dental officers as follows: 

"This dental department of ours is an extremely important factor 
in our hospital work, and I simply do not know how to frame ade- 
quate words to convey my appreciation of the work done by Capt. 
Gow and Capt. Mallory. There has been no other dental depart- 
ment opened here so far, and these men have tried to carry on for all 
the British troops in this district. The number is well over 100,000, 



OK AL HKAl. I H 127 

and their clinic has been besicgrd from morning (ill nighl by men ol 
every rank I he department U working to hard that I am |uft a 
little nervous for fear tlie^c men will play out. and have miaird • 
they take off at Nasi a half day each week. Ilie tlram m CCff^uu^ 
beginning to trjl. I frcl that under the circumstances wr fhould have 
another dental surgeon with us. as practically cvciy man cominf ioto 
the hosi)ital requires more or less dental treatment. The coodrtiao ol 
the I ommies' mouths is simjily l)ad liryond dev:ri|>lion I 
I do not exaggerate when I say that each man coming m 
the attention of a dental surgeon for from one to ten hourt ol hit 
time. Even then the relief given would be only of the moti lempor 
cry character.** 

Since the above was written. Capt. G. C Hume, of 1 or- 
|)erformed such splendid service in efficiently organi/ing th- 
service at Niagara Camp last summer, has been attached lo Na 4 
Base Hospital, and thus will soon be associated with CapC. Gow 
and Capt. Mallory in the excellent serMce which these men air 
rendering the Allies in Greece. 



Acknowledgment. 
Dk John 1 f.f.tzf.l. of Bfjimlda. 



DK. JOHN TRFTZRL. Dental Sur«rnn. H^rm ;.i.i. ^-■ • • 
usual three months' vacation, during the pa*t m;: r :>-? .^^^:^t::l^ 
Ca|)tam Hume at the dental clinic at NiaKi-'i ^ i: •; Ilie 
following letter indicates that Dr. Teet/ers action wa« a()fifccialr<L 
not only by the dental officers, but by the militia authorities at well 
Mil. I HA AM) DKFFNt F. CANADA 

Niagara Camp. 20lh Sr|^ . 1^15. 
Captain Hume. 

Dental Clinic, 

Niagara Camp. 
Dear Captain Hume. Vt'ill you be g*-^^? ^«.,...»K in ron«^^ to 
Mr. John leel/el the very deep sense of . hi irr 

the very generous service* which he rendered here during Kw vacation 
It is just an example of that splendid servKc which to r ^enul 

surgeons are giving at the present crisis at great finam*^! *-«».nnc^ 
to themselves. 

1 know that the Minister fully concurs in thit c\\^tmen ol k ^ 
tude. and Mr. leet/el may very well feel that he ha* done K» ImI m 

this great crisis. 

^ miM itncerlv. 

W A^ I.OGIR. 

x^olonei, 
O. C 2nd Oil 




Complimentary copies of 
Oral Health will be sent 
during the progress of the 
war to all Dental Graduates 
on active service whose 
army a dress is known. 



Vism jiWWjwxwmimi'MMMmmmmmmmmmsA^mm^^^ 



HOXOR ROLL 



ES^j 



M Major C. E. Sale, 18th Batt.. 4th Brigade. p| 

g ^j 



CANADIAN ARMY DENTAL CORPS 
Overseas* 



Lt.-Col. J. A. Armstrong. 
Major O. K. Gibson. 
Major A. A. Smith. 
Capt. J. W. Bell. 
Capt. C. Brown. 
Capt. J. F. Blair. 
Capt. G. N. Briggs. 
Capt. W. J. Bentley. 
Capt. G. S. Cameron. 
Capt. O. A. Elliott. 
Capt. E. A. Grant. 
Capt. W. R. Greene. 
Capt. George Gow. 
Capt. O. G. Hassard. 
Capt. J. E. Holmes. 
Capt. G. G. Hume. 
Capt. F. W. B. Kelly. 
Capt. H. Lionais. 
Capt. F. R. Mallory. 
Capt. A. E. MuUin. 
Capt. B. L. Neiley. 
Capt. E. B. Sparkes. 
Capt. G. H. A. Stevenson. 
Capt. L. N. Trudeau. 

tMajor W. B. Clayton. 



Capt. G. C. Bonnycastle. 
Capt. F. H. Bradley. 
Capt. C. D. DesBrisav. 
Capt. D. M. Foster. 
Capt. W. Y. Hayden. 
Capt. Jas. M. Magee. 
Capt. H. L. Mitchener. 
Capt. S. H. Simpson. 
Lieut. J. T. Adams. 
Lieut. S. G. Alderson. 



Capt. A. W. Winnett. Lieut. 

Capt. C. F. Walt. Lieut. 

Capt. J. E. Wright. Lieut. 

Lieut. H. F. Alford. Lieut. 

Lieut. G. Atkinson. Lieut. 

Lieut. R. H. Atkey. Lieut. 

Lieut. W. A. Burns. Lieut. 

Lieut. C. H. Bray. Lieut. 

Lieut. G. W. Bray. Lieut. 

Lieut. H. Clarke. Lieut. 

Lieut. A. R. Currie. Lieut. 

Lieut. G. H. Fowler Lieut. 

Lieut. A. A. Garfat. Lieut. 

Lieut. W. H. Gilroy. Lieut. 

Lieut. D. H. Hammell. Lieut. 

Lieut. J. W. Hagey. Lieut. 

Lieut. H. C. Hodgson. Lieut. 

Lieut. E. W. Honsinger. Lieut. 

Lieut. E. C. Hutchison. Lieut. 

Lieut. R. Jamieson. Lieut. 

Lieut. J. L. Kappele. Lieut. 

Lieut. E. J. Kelly. Lieut. 

Lieut. O. Leslie. Lieut. 

Lieut. A. G. Lough. Lieut. 

Lieut. C. A. McBride. Lieut. 

Lieut. W. G. MacXevin. Lieut. 

Concentration Camps 

Lieut. X. S. Bailey. Lieut. J. 

Lieut. D. J. Bagshaw. Lieut. R. 

Lieut. J. A. Beatty. Lieut. J. 

Lieut. F. C. Briggs. Lieut. J. 

Lieut. T. W. Caldwell. Lieut. W 

Lieut. C. E. Campbell. Lieut. R. 

Lieut. E. H. Campbell. Lieut. H. 

Lieut. A. V. Cashman. Lieut. R. 

Lieut. E. H. Crawford. Lieut. J. 
Lieut. Karl Damon. 



C. E. McLaughlin. 
R. McMeekin. 

B. P. McXally. 
E. McXeill. 
H. C. Macdonald. 
J. W. Macdonald. 
E. D. Madden. 
V. C. ^'. Marshall. 
L. L. Matchett. 
G. V. Morton. 
J. F. Morrison. 
J. B. Morison. 

C. H. Moore. 
P. E. Picotte. 
H. Ross. 
J. Roy. 

\7. A. Sangster. 
J. F. Shute. 

D. P. Stratton. 
R. C. H. Staples. 

E. S. Tait. 
L. A. Thornton. 
H. P. Thompson. 
H. P. Travers. 
D. D. TVilson. 

Karl F. "Woodbury. 



M. Deans. 
L. Dudlev. 
H. Duff. 
X. Dunning. 
. R. Eaman. 
'^. FeU. 
B. Findlev. 
W. Frank. 
P. Gallagher. 



lActing Director of Dental Ser\'ices, address Ottawa. *Lieutenants rank as 
Captams while overseas. C.A.D.C. overseas address — Care Director Dental 
Services, Canadian Contingents, 23 Earls Ave., Folkestone, England. 



o ^ 




—M / — ^ 



Concentration Camp». — (Continued.) 



Lieut. 

Lieut. 

Lieut. 

Lieut 

I.,l««ut. 

LIfUt. 

Lifut. 

Lieut. 

Lieut. 

Lirut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lirut. 

Llout. 



rapt, 
rnpt. 
rapt. 
Capt. 



O. 

J. 

W. 

II. 

I'. 

F. 

n 



K. CJlinilan. 

S. (•;irvin 

T. n 

J. H' .1. 

J. II.h1.>. 
IIlnd.M. 

(MI IIolllnk'sli«>nd. 
H. <'. Jf-ffrey. 
(V M. Joyr... 
l''r;iMl< KiiiK'ht. 
L. L«*mlre. 
r. H. I^vey. 
C. ('. MfU'Inrhlnn. 
If. ('. Mann 



Lieut. 
LIfUt. 
Lirut. 
Lieut. 
Lieut. 
Li<«ut. 
Lieut 



W, 
K. 

I) 
\V. 

w. 

L. 



J 

F 
K 

s 

H 
I> 
A 



it. 



"*:. 



Lli'Ul. Otto 
Lieut. H. A 
LifUt. J. ft 
Li«ut. R M 
Lieut. F. H 
Lieut. W. H 
Lieut. J. W 
Lieut T. !•: 
Lieut. J A 



M 

.M 
.M 

M 

M 

Mutin 
N '»■<•• 

N.f.bllt. 
ONril 

!•«• ir<»ck. 

Qiilnn. 

l: 
i: 



w 

ir 



nathmwim4. 



Uvut 



11 



Divisional Officer* 



T. 
A. 

ir. 
I'. 



C Rruce. 
Dubord. 
T. MinoKue. 
V Sh.iw. 



«'apl. 
("iipt 
Cipt 






ft T- 
I K 

r, r 



W. J T»rlar 



J M 



ATTACHED TO CORPS OTHER THAN C A DC 
Overteat 



Major I'. I' 



I'npt 

rapt 



J 1. 
f4 



M.-T^^n. ?^rh fH^? 



Itjillnrhey. 58th Itatt 
Major (;. S. <'a?^^^^ro^. r»th ('MR. 
Major V. T. ('oK'iilan. 2r.th It.ittcry. 
rapt. K. r. rninpb.«II. •13rd F^itt 
r«pt. Chnii. A. CorrlK »n. Army 8«tvIc«' 

('orp». 
("apt J. R. Duff. Tr)th Hntt. 
rapt. J. Han>«'r. Ri»yal Navy 

Concentration Camps 
Fl K Armjitronc. l&9th .sUj.r N ^ 

l*ai»t .\ 
II. A CroU. lOth ('MR Unit C 

Neil Smith. 180th Itntt. U*u%. C H Wrt«*il. »Mk U*U 



I 

I 

IMe 



H V 



irUtt. I 



IJeut Col 

Matt. 
Lieut. -('«»l 
U<«ut.-Col 



.__ .. Alt t. f I • I f 



F. H. Parry. r.A.nc 
A. ('hainbi'm. t'A IX' 
R II. niion. 71nI K >tt 
J. K. Dorejt. ('.A I» <V 
R. Cnrfat. 7Ut Hntt 
J. K. Irwin. r.A.D.r. 
J. T. IrwiiH Itii r ofT «'o 



UNDERGRAOUATCS 

Ovf ricAi 

A W 
J V I. 

J O I. 

II It I 

\V (' I 
K S M 

«' F M.' . r • • 

Concsntration Campt 



Lieut R M ItmixMir (4th Itott 

II ^^ Mean. l?>'Jlh Halt 

R m.Mtiop. (• \ l> •' 

A. F. ("heirwln. f>«ith Bull 

F. Clufr. I^l"! lt«M 

F V KtlloM. «♦ V I» <• 

II (1rr.MiNVo.>.1 " •' '• •■ 

('. M M.Imj:. P , • 

(1. \V, Mow -on. :. 

T. If. Hutrhln-ion i* X !• «' 

J. T. Irtiln. 4lh V. Co 

O. O Jewlft. Firld Amb 

A. N. Iw»ldlnw. Mnrh. dun 



A 



J ORAL HEALTH i 



EDITOR 

WALLACE SECCOMBE. D.D.S.. Toronto, Ont. 

CONTRIBUTING EDITORS 

GEORGE K. THOMSON. D.D.S.. Halifax. N.S. 
F. W. BARBOUR. D.D.S.. Fredericton. N.B. 
ASHLEY W. LINDSAY. D.D.S.. Chengfj Sze Chuan 
J. WRIGHT BEACH. D.D.S.. Buffalo. N.Y. 
T. W. WIDDOWSON. L.D.S.. London. England. 
J. E. BLACK. D.D.S.. Vancouver. B.C. 
MANLY BOWLES. D.D.S.. Winnipeg. Man. 
J. A. C. HOGGAN. D.D.S.. Richmond. Va. 
EDGAR D. COOLIDGE. D.D.S.. Chicago. 111. 
RICHARD G. MCLAUGHLIN, D.D.S., Toronto. 



Entered as Second-class Matter at the Post Office, Toronto. Sub- 
scription Price: Canada, $1.00; Other Countries, $1.25; Single Copies, 25c. 

Orig-inal Communications, Book Reviews, Exchanges, Society Reports, 
Personal Items and other Correspondence should be addressed to the 
Editor, Oral Health, 269 College St., Toronto, Canada. 

Subscriptions and all business communications should be addressed 

to The Publishers, Oral Health, 269 College St., Toronto, Canada. 



Vol. VI. 



TOROMO- MARCH. 1916 



No. 3 



H 



E D I T O T^I AL 



H 



A Canadian Department of Health. 



DR. STEELE, M.P., North Oxford, Ont., introduced a reso- 
lution in the Canadian House of Commons recently expressing 
the greater need at the present time for a national department 
of health than at any previous time in the history of the Dominion. He 
pointed out that while all Provincial Governments maintained well 
organized health boards, the Dominion had the control of many 
matters relating to the health of the people distributed over eight or 
ten departments of the Government. Practically every European 
nation, \vi\h one or two small exceptions, has organized national 
health departments, but Canada lags behind. He spoke of the 
progiess made in the United States toward a department of health; 
also in Japan. There was urgent need for such a department in 
Canada, as at the close of the war there would in all probability be 
a greater influx of immigrants than ever before in the history of the 
country. He believed that 40 per cent, of the babies dying in Can- 
ada every year could be saved. It was promised by the Government 
that the matter should receive due consideration. 



New Establishmrnt 



Canadian Army Drntal Corps. 



Ti ill Canadian Army Dental Cor|>s. though organi/ed imcc the 
commencement of the war. has amply justified ilsrU by tbc 
large measure of useful service already accomplished. The 
corps, having been established as a separate unit. occ4Uioocd a coia- 
plete readjustment of the dental services in the Canadian Nlilrtia. 
Status quo, that arch enemy of progress, was of necc«iity loinewhAl 
disturbed, resulting in a lack of co-operation in certam di/ectiooa, 
amounting almost, in some case*, to active op|>oiiition. Unfortunately, 
the Dental Corps has received the least help in a quarter where it 
naturally might expect the greatest encouragement and assistance. 

1 his lack of co-operation in France has been partKularly unfor- 
tunate, and has resulted in soldiers being sent to Kjigland for denial 
services (or in their being deprived of those services altogether) that 
might, under other circumstances, have been readily supplied in 
France. An army officer who deliberately stands l)etwern the tol- 
dier in the trench suffering what Burns has called "the Hell of all 
diseases." and the dental surgeon who is ready and anxious to gurr 
relief and comfort, is unworthy of respect or confidence SCAading 
upon prerogatives, erecting barriers of regulations, weaving ftltaDfie» 
ments of red tape, impeding the work and altem|>tmg to retard the 
development of the Canadian Army Dental Corps Overseas, is noth- 
ing less than "disgraceful conduct in a professional res|>ect," and yrt 
that is precisely what seems to have occurred "Somewhere m France** 

Opposition of such a character will ultimately result in advantafe 

to the dental corps. Strength and esprit de corps vnW be developed 

and a more solid found.ilion laid u|>on which to build the « <• 

ture of the C A I)(V than would otherwise l>e potilble. U !» *>«|y 

as difficulties are met .md overcome that the strongeil and beil qyAll* 

ties are developed Ihis new corps will, we l>elie\e, not only "i 

its spurs." but earn the esteem and confidence of the enlve 

because of its devotion to duty, the efficiency of its work, and the 

im|)ortant service it will render 

* * ♦ ♦ 

FJsewhere in this issue will be found an article, wrillen by 04^4. 

Trelford. outlining the early organi/alion of the C A I ^ttd a 

report on the work recentiv accomplished at the I or onto i Am^' We 
also publish a rrp<nt on the dental work accomplish*"'! b^ the C \ 
DC. in I .ngland and ()\er*e.M from Julv 1 >th to •!• 

1015 

The CADC has already oulgro%im ilt ortr"-' -..M..k.,.^ 
The tremrndt>ii* demands thaf h^ve been maor . id 



132 



ORAL HEALTH 



the growing need for dental services in the militia, have occasioned 
a new establishment that the situation might be adequately met. 
Major Clayton having spent six months overseas, returned to Ottawa 
with practical knowledge of the needs of the corps, and was invited 
to draft a new establishment that would make the dental corps more 
efficient and better able to bear the extensive burdens that have been 
placed upon it. 

Major Clayton has rendered most excellent service in securing, 
under this new overseas establishment, greatly improved standing for 
the C.A.D.C, and the elimination of many disabilities under which 
army dental surgeons have been compelled heretofore to do their 
work. 

Militia orders covering this new establishment are as follows: 

Militia Order No. 80. — Canadian Expeditionary Force — 

Establishment — Canadian Army Dental Corps 

— Amendments. 

With reference to Militia Order 257, 1915, the following amend- 
ments are authorized: 



Headquarters Staff. 

D.D.G.D.S 

Adjutant 

Research Officer 

Dental Officers at Headquarters, 

London 

Quartermasters 

Assistajit Quartermasters 

Sergeant -Major 

Quairtenmaster- Sergeant 

Assistant Quartermaster- Sergeant 
Clerks 



Bat- Total 
Officers W.O.'s Q.M.S.'s Orderlies men PersonnelHorses 



Total 



At Corps Headquarters. 
Each Infantry Brigade 

4 Dental Surgeons (3) 

Total 

At Corps Headquarters. 
For Services Corps troops 

2 Dental Surgeons . . . 

Total 



12 

7 



A.D.D.S 

D.A.D.D.S 

Each Infantry Brigade 

4 Dental Surgeons (3) 

Each Artillery Brigade and A.C. 

1 Dental Surgeon (4) 

Each Field Ambulance 

1 Dental Surgeon (3) 

Each Stationary Hospital 

1 Dental Surgeon (2) 

Each General Hospital 

2 Dental Surgeons (2) 

Each Base Stores 

1 Dental Surgeon .... 

Each Advance Stores 

1 Dental Surgeon .... 

Each Casualty Clearing Station.. 

1 Dental Surgeon .... 

For remaining units of Division.. 

2 Dental Surgeons . . . 



1 

1 

12 
4 
3 
2 
4 
1 
1 
1 
2 



Total 32 



12 
6 



12 

7 



23 



36 

23 



1 
1 

12 
4 
3 
2 
4 
1 
1 
1 
2 

32 



1 
1 

12 
4 
3 
2 
4 
1 
1 
1 
2 

32 



3 
3 

36 

12 
9 
6 

12 
3 
3 
3 
6 

96 



10 



ORAL HRALIH 



133 



KaNK of OFFKT.fLS OF CANADIAN AkMY Df.MAL Cukt^ 

(0\FJO>LAS). 
Ilic Deputy Director General Dental S«rvKc» to b« Lt.-Cokiaci 
Senior officer with each Division -Lt. -Colonel and one Ma)or 
l^escarch Officrr to have rank of Major. 

Remainder of overseas officers, other than Honorary rank. Iw i»««e 
laiik and |)ay of Captain. 

Orderhes to be Mechanical Dentists, and to have rank of Scffcaat. 
Batmen to be Privates. 

Noltv TIm« liKurt-^ III |iiu-i<titl)<- . I'Moto thr nun • ''•- . !« A 

DIviifion. 

Canadian Army Dkntal Cot r* ' > 

SHowi.N*; i.\<'iji:\sH i.\ ?ilop«>si:i. .\ kst 

Present BiiUibUiihment. I'mpntvd K 

Staff. BlMtt. 

lA. -roloncls I 

Mn j«vm I 

otht-r Offlcnm ; 

Nil. S r.ii.'m and nK>n U 

Total Nil Toitl ;: 

tX^MIWHATIVE STIlKNliTH I'KIl IHVI8ION 

.MaJorM I l.t -I'lOiinfli t 

(*a|it:ilnM 18 .Xlnjiirii I 

N.<*.(>.'i4 and men . 3S i*itptalnji 7» 

— N.CO.'n and mtm * < 

Toll I '.: 

To«al 9t 

y^ pm I' 
U.-Coi. I 

Captain* > 

Total ( ffU-vr* n 

SCO.'n n 

Total N nd tmmm :< 

To' :tw-»r«. "• 

Total r^ 

Canadian Akmv Dkntal Corps-Homk Siknicc. 

TMal 

iMH.r*. <>rtlefll»a llalin»« l*iy i i— ni l tlar«tta 
I><:i>S luxl AuMlMtant. H«mI* 

(luartiin*. Ottawa 1 ^ * * ^ 

Ut nivlHion i • ■ *• ■ 

2ml IMV.-...M 14 14 H JI I 

ar.l 1 11 'J 'J H • 

4th i • • ! f! 5 

Mh 4 « « " I 

«lh I M H J 

No I . »rv nutrlol U U _ J 

No n .\lilnir\ niirl.t 13 l! il 2 • 

No 1.1 Mn!'.t'\ iM.trtil IS II II » • 

Ono iju 1 '"r for «a4\h Dl- ,. 

vUl».« rlrl t » *' 

Total m '" >•« »^ • 

No doiil)l thr establishment for Home SmrKe t» only ni«scrti««. 
as already more dental offu rrs than the numl>rT wckalgd ^W^ at 

work 111 i-rrlain divisions and many more will "-•' re !o Kr addrd lo 
meet the demands of the seNeral coi\'*% 



134 ORAL HEALTH 

It will be noted that this new establishment provides for a research 
department for the accumulation of statistics and the study of prob- 
lems peculiar to war conditions. The complete change of diet of an 
army in the field, for instance, or occasionally, the complete absence 
of water, and the relationship of these problems to dental disease 
and treatment are worthy of special study. 



Lieut. McLaurin Wounded. 



WORD has been received that Lieut. H. J. McLaurin, 43rd 
Battalion, Winnipeg, has been wounded. We are glad to 
report that Lieut. McLaurin's wound is not reported as being 
serious. 



Casualty — C.A.D.C. 

THE following message was received at C.A.D.C. Headquar- 
ters from Captain E. C. Hutchison, "Somewhere in France": 
To the O. C. Canadian Army Dental Corps, Shorncliffe: 
Regret to report Sgt. N. W. Snape badly injured by shell fire. 
He has been sent to the rear. At the present moment I can't tell you 
just where he is. I think he will probably be sent to England. 
It happened about one o'clock on Tuesday, Feb. 1 5. 



Dr. Cummer's Complete Article. 

ORAL HEALTH is to publish Dr. Cummer's complete article 
on "Partial Dentures," commencing this issue, and continuing 
in the April and May numbers. The manuscript is abund- 
antly illustrated, there being no less than one hundred and sixteen 
illustrations in the series. There will, no doubt, be an unusual demand 
for these issues of Oral HEALTH, and subscribers are urged to pre- 
serve them, that the complete article may be available for study and 
future reference. 



Major Clayton on Western Tour. 

MAJOR W. B. CLAYTON, Acting Director of Dental Ser- 
vices, Canadian Army Dental Corps, addressed a meeting of 
Winnipeg dentists and their friends on the evening of March 
14th, and on the following Thursday spoke before the Canadian 
Club of Calgary at their noon luncheon, and during the same even- 
ing addressed the members of the Calgary Dental Society. 



Artificial Dental Rxcrcisc 

Tin. ( oii.stant clicwing of gum ovrrtajict 
the salivary glands to such a drgrcr thai 
thrre is httic rrs|)onsc to the nonnal 
stimulus of food, rrsultmg in quantities of olhef 
lujuids bring swallowed during a meal m an 
attempt to supply the loss. ["hr irritation lo 
{\\v stomach occasioned l)y the abnormal flow 
of saliva between meals, and the displacement 
of saliva by other fluids during meals, cause 
those digestive disturbanre^ which usually 
accompany this objectional)le habit r.xercise 
the teeth by all means, but exercise them i» 
Mother Nature intended by the mastication 
of properly selected food, and not by an arti- 
ficial method ^urh as the chewing of gum 








-^ a, 



rt 



en 
CU 

cc 
o 
U 

< 

H 
Z 

Q 



O I ^ 



O 



So- 

3 w 



< 

< 

5 
< 

< 
U 

X 
H 

o 

CO 

cc 
la 
u 

u, 

o 

o 

D 
o 

a 

< 






H 



*-5 t><!l 



^1 K 



H 



;^^ 



r. o c 



^ 



m 




Ol?AL HEA07\1 

\ JOIRWI ril\I sT\M»*. M)H 111^ -IHMT (W 



JS 



\n| 



M m:< ►n h • \i'i;ii . I'Mf. 



N... I 



Buffalo Letter 
By Habec. 



Blind Faiim! An Illustration 

HAHl.C has appi-arrd hrforc ihr readers of OraL HF-ALTH m 
a variety of rolc5 illustrating thr vagaries of his menial idwim. 
hut his last one literally clunipcd him from thr frying-|>an into 
the lire. It was all on account of the I rhyme that ' a 

lemon instead of a Iinie. hut meant in K""^* r**'* ^*> * '' ' *® 

>how Dr. LeuniiMi W dugh the proper reik|>ecl A Ir' <il 

Mahec's good friends says that he took a year's chance on OUAL 
HlJVl.TH to read what "Hahec hat! lo say lo ihe dental wofld." and 
the mongrel rhyme is what he lirew in the first number \X h«ihcf ll 
he a loyal s.urifue on the alt.ir oi frieiuMup. or an iifr. fr»» ^tr in- 
stinct of the gainhler that precipitated such fiK)Ihard> • 
Habec wots not. hut he. neverthelett, is much gratified al ihe ituH 
reposed in hiin 

In view of the (oM^omn illumMi.ihon. Hahec hn- * *— * *'^ • --nr 

out into the open and declare himself \%illing to t|u-« »# 

class, ready to meet all comers of his weight Jml lh» our. |4r«»r. 
dear reader; he prt>mises never lo do il again VI r . <»• 

fpicahle way to use old friends, hut he feeU .imilhrf 
inside spoiling to get out. so here ci>mr» the trU of . — 
Vt e imploie voii to remain neutral 

¥ ¥ # « 
I he following lines aie dedKaled lo ihe l>oys ol 



138 ORAL HEALTH 

who have so nobly responded to their country's call, and of whom we 
are proud because of their great sacrifice and splendid service. 1 he 
dentists of Canada rallied almost to a man to the spirit of service 
peculiar to their calling, by restoring the teeth of the otherwise unht. 
Thousands of good soldiers have been recruited m this way and an 
added honor and significance given to one of the greatest of all pro- 
fessions Whatever may be the issue of this terrible conflict, or the 
final relations of the Union Jack and the Stars and Stripes, the ranks 
of the dental profession under both emblems shall become more 
closely cemented through the common bonds of their professions 

righteousness : 

The Dentist's Reveille. 

In quiet ville, in busy mart. 
At seaport town, through country's heart. 
Across the plain, o'er mountain top 
The wave rolls on ; it cannot stop. 
The bugle blast, so loud and long, 
Calls to the weak, inspires the strong: 
It chills the heart of faithful wife 
And speeds the husband to the strife. 
It sends the dread to mother's heart. 
Father and son are forced to part ; 
Perhaps to meet 'mid cannon's roar. 
Or yet, mayhap, to meet no more. 

A privilege her son's may pray 
To serve beloved Canada, 
To buckle on the armor grand. 
To fight for their own fatherland. 
And paint on history's glowing page 
The sign that will to every age 
Tell of glorious victories won 
And valiant deeds so nobly done. 

And when the final score is made. 
That awful debt is fully paid. 
No men of all the fearful toll 
Have given more of life and soul 
To Him in gratitude and thanks 
Than those recruited from our ranks. 
Wherever duty bade them go. 
E'en to the lines of sturdy foe. 
No yellow streaks were ever seen. 
No weak backbone or chicken spleen 
To dim the lustre glorified 
By love and duty sanctified. 



ORAL HRALTH IJ9 

**\1> counlr) tl5 of thrr. 
Swcrt land of libcily," 
lliis life to ihcc I give. 
Nor would I wish to livr 
To hold from ihrr that %cr\K.r «ji.- 
From thinr own wn who*c hrart ktrMH true. 
And when at last 'tis cold and ftill. 
Soft comes an echo, the dentist's rrveille 
* * ♦ * 

\^ c may as well put in another one so that you v»ill be uufeiled 

and never want any more from this source: 

'Mkmbf.r th' Iimf-? 

Down where the sparrer ha* her nest, 
Je5t up over the bull fro« f>ooI. 
Hid by mo5s on an old dead »nag. 
And shaded by a big toadstool. 
Jest north by east a foot or two 
Is the purtiest hump I know 
Fer a feller to sit or lay an' snoo/e 
An' fergit thet he'd orter go. 

It's jest as round as a Northern Spy 

An' green with softest grass. 

All padded like the parlor chair 

An* smooth as apple sass. 

Gee Whi/! but that's some fishin* spot 

flight immegially after rain. 

An* if y' miss it after this 

Y'vc got yerself to blame. 

^'ou git yer can of nKe fat wonm 

An' 'bout a rod o* line 

An* have a good live saplin' \hAc. 

By hick*ry. y*ll have some time 

Jest figger that a milkin' pail 

Is 'bout the {>roper si/e. 

An' if yer wishbone's any good 

^ 'II fill it 'fore y' rise 

Ihem bullheads must In* ; 

The way thr. ' an' bilr. 

Iliey act as .; . coultin't wAit 
Hut jest go right in an' 

To git thet little piece of worm 
Away from all the re^t. 
As if they want • « ' '- -" f-«n 
An' more. ton. I 



140 ORAL HEALTH 

Sech fun as that don't come along 

On every blessed day. 

But jest on extry specials, like 

When nothin's in the way. 

And then agin some times y'll fish 

Y're goldurned head most off. 

But seems them pestiky bull-pouts 

Jest stand an' grin an' scoff. 

Like old Hy Sutch does when he gits 

His airy feelin's on 

Jest 'cause he leads the G. A. R. 

An' bangs th' old bass drum. 

But you jest stick around awhile 

Until old Sol goes down. 

Then drop a nice fat wiggly worm. 

An' don't y' make a soun'. 

Be sure it lands outside the root 

Next to the rotten tree, 

An' if y' don't git two at onct 

Jest take it out of me. 

An' then jest as its gettin' dusk 

Y' peel off all y'r togs. 

An' dive off from the crossin' plank 

Between the old oak logs. 

A splash, a swim, a dive agin. 

Oh. Gee, how cool y' be! 

Them pesky chores is easy now 

Y' feel so light an* free. 

pft ^ •fi iji 

Ostensible Integrity. . 
That sounds a little like some new attachment for an automobile 
or a freshly discovered organism, but the dictionary tells us that in 
reality it's a sort of fake honesty sometimes made use of by certain 
dentists who are indigenous to various parts of the U.S.A., Canada 
and the rest of the civilized world. No mention of Mars, Porcupine 
or Chicago is made. But if you can define the confines of your 
"piofessional character" and get a good radiograph of it, perhaps 
you might find numerous rarefied areas indicating the presence of 
"ostensible integrity"; and again, you might not. But in case you 
did we would give you the benefit of the doubt and dissect away the 
"ostensible," and label your moral ingredients non-poisonous and 
chemically pure. How many of us use ostensible integrity as a gen- 
eral filling material? We may place a beautiful gold inlay, but the 
cavity may be lined with O. I., and when it comes to root canal 
treatment and filling, why, it has become a standard preparation. 



OKAI. HKAI. I H 141 

OwiriK to the fact tliat it can \>r u^rd in unlirnitrcj ? \n(i cuta 

l)inali(jn5. the possihihly of it* universal apphcation f •• «•• rn- 

sidious and shifty commodity to traffic with At U . nit 

don't suspect us of using it. hut when they fmd out. rt't all off %rrtli 
Uncle Dudley, and nothing you may do will Mi you nghl wiiK ihrm 
again. 

The canaliculi and the deep cells of the jawt ol the <i^iti/rd 
peoples of the earth are veritable catacomb*. ^Iled with n ol 

the dead and 5luml)ering issues of ''ostensible integrity " hor dr* 
cades at a !^lr<*lch tiny may hide your secret and prevr\r % mu- 

tation until, on some fateful day. the gay and fr*»"^- -' ••• 

\eridens drops in for a social call, awakening th** 
who in turn attempt to throw out the dead onr^ » 1 the tcrap a 
on. With stre-pto sicing them on. the war dance is started, and with 
javelins and battle axes they lay siege to the walls of the citadel. 
jabbing their way through the battlements, and with a last ftu|ifefnr 
effort, burst forth in fetid, putrid hordes into an otherwise tweet and 
pure vacuum chamber which was the pride and )oy of Kxne fastidi- 
ous peaches and cream package of dimples heretofore uncontami 
r.ated by sordid filth. 

I his IS one of the situations we are creating every day by way ol 
glorifying our nobh* calling When, instead of working its way out. 
the explosion backfires and throwns untold millions of lhe»e nomadK 
militants into tin* blood siffam. they may hnd lodgmv ' 
between the bump of self esteem and the big toe A« • 
various crews of bug hunters, dire results follow a % ' ihne 

health pirates, and one authority avers that more than one hundred 
thousand persons are re(juired to pay this annual toll Our own 
I -eumen Waugh raises the ante four times on the other fellow. '^*— ^' 
seems rather an extravagant statement: howe\er, not l>eing a: 
interview any of the departed at this time, we will have to take lhr«e 
stat<-ments for their face \alue 

Perhaps, for our own peace of nund. we might *i • 

but even so. the figures are appalling and put a ^i 

the ingrown sense of appreciation of the «u|>eriiH abilily wr 

have always known ourselves to |H»Me^* Vl'hv should we frri N 

necessary to agree with those who do not » with us ^ Nci€ 

only are we satisfied with our own intellectuxi ' '■ ' 

admit It: so why should we be disturbed b> v 

1 lowever. let us divorce the two words at the head of ihw linn and 

lake the lallei one for better or worse, never to |»ait It » fcnl ol all 

the virtues, and will preset \e hainionv .imong r 

mav be fortunate enough \o |Hnse^» it x»ill I 

will be fouiui the most useful part of y»Hii «»rti« r- 

however, has found his ra(iiograt>h to l>e c 

with ostensible integrity, and to avo*d crea' 

be IS in a position to preach, he owns up to tH-irm »-• •-• •■—' 



142 ORAL HEALTH 

ideal in this respect that he presents himself to you as the horrible 
example rather than the one to pattern after. 

Appendix-itis. 
Habec has thought long and seriously on the utter profligacy of 
the great Wilhelm with the lives of his soldiers, and has come to the 
conclusion that he has an eye for the war game in the next world. 
The greater number of the faithful he can transfer to Beulahland, 
the greater the army that will be awaiting his arrival to escort him 
to the goal of his ambition. But suppose Saint Peter should point 
"thumbs down"? What a joke on the Emp. that would be. 

February 18-19 last we had the annual alumni meeting of the 
dental department of the U. of B. About four hundred of the faith- 
ful dug up the annual dues, which shows that the boys pull a tooth 
now and again. Occasionally we meet with one who exhibits real 
affluence for which they are ofttimes duly sorry. For instance, Abram 
Hoffman, the genial, has been sporting a handsome twenty-four carat 
fur-lined overcoat, which was the pride of the family. During the 
festivities he deposited it in a conspicuous and supposedly safe place. 
It is still safe from his possession with every prospect of a continuance 
of the same. Habec's coat laid beside it, but evidently the exponent 
of annexation was a person of refined and fastidious tastes and not 
a collector of antiques. Moral: If your coat isn't worth checking 
for ten cents, it will be safe even at prayer meeting. Sorry the cold 
weather continues, Abe. 

We were favored by the presence of several good fellows from 
out-of-town. First in order of their appearance came Elmer Best, 
of Minneapolis. At the very start he showed that he was the super- 
lative of good, both in name and in the exempHfication of the subject 
of root canal treatment and filling. He thoroughly convinced Habec 
that the Best way really is the best way, and as a delver into sub- 
maxillary intricacies we are ready to back him on general results. 
Of course we disagree with him in lots of ways; however, his word 
is as good as ours. Dr. Best is a young man who may yet wear the 
gold and purple of our fraternity as well as to carry the cross. A 
field of righteous endeavor and thanklessness is before him. 

Only a few isolated dentists are living who have not heard of, or 
do not know, Donald Mackay Gallie, who resides on the fringe of 
Lake Michigan, and is the last man to be shunted from the presi- 
dency of the N.D.A. He did some good team work with himself 
at the Alumni Association banquet during the meeting, and every- 
body was delighted with the way he shot the gentleman cow and got 
away with the remains. Dr. Gallie is surcharged with the essence 
of good humor and is glad to be alive to give each new year the glad 
hand. He's a twenty-four and three-fourth's parsnip scintillator, 
all wool and almost a yard wide in places. We were trebly glad 
to have him in our midst for a day, and hope he will try us on again. 



O F< A I . H I. A L 1 H 143 

JcMcpli I irad. who has for srvwal decades past brushed hn i 

Philadelphia, journeyed to Buffalo just to tell us alxxit a mi v 

how famous a little thing can make a big man. He it nghl about il 
all. and we arc strong for him because he is sensible, pr 
cere and honest If we should say all we would like lo aixjui rum he 
would have nothing left to put in his new Ixwk. so we %«ill ileal oo 
more of his thunder. Buy the book and read what we %vtiiild tay 
if we had space, and bear in mind that Dr. Head has done more 
for the cause of pyorrhea (your pardon. Dr. Head, we should have 
said mouth infection) than all but a select f'-v^ It was a case of 
getting in Head-first. 

Habec cannot mention the clinics exce|>l that of I oronlo's o%«ti 
I-.rnest Cummer. He showed some splendid work m connection %nlh 
partial dentures, and excited a great deal of interest in and adnura- 
tioii of his system, which was replete with novel and original ide** 
He is on the right track without doubt, and will do much lo • 
the means of correctly placing partial pieces Over on Woodrow s 
side he is looked upon as one of the few greatest profthodoolMts ol 
the present time. I.rnest Cummer is a most appro|>riate name, f"* 
he exemplifies the first one and surely is all that the surname imp 
We could say much more about him. but we don't want him lo ijet 
chesty. Under so able a cha|>erone as Dr. Clappison. of Hamihon. 
Dr. Cummer beha\ed verv creditably while in Buffalo 



Glycerin as an Antiseptic 

WlilLl. glycerm h.is King been regarded a* )HM*r«Mnf 
degree of antise|)tic power, it is (|uite recently that it hat been 
proved to be a most admirable sterili/ing agent, i^articu 
suited for rendering surgical instruments absolutely afte|ilic wtihoul 
injuring them as to temper or surface, says the nigat In the C he- 
niH(fr Xcilufi^ (Cothen) we find an account of the ri|»*-»in»riit» mAyir 
by G. Seiffert and A. Spiegl to test the \alue of . 
respect, as taken from an article in the Zcnt hi liak ' *l ^ 

Bacteriology). The lest was made with bacilli of lulH-uuiottu, aad 
it seems rather ominous to be assured (aMi.tllx '^^ »• 'h<^ «f '^••^^ 
obtainable .it any abattoir! When heatril m - at a t 

ture of 120 degrees centigrade, every germ tested was co»i 
killed at the end of one minute lliis included no! 
of diphtheria, anthrax, and chu krn iholrr.i. but r' 
Par.ilyphus B Bac. pyocaneus. Bac sublilu. \ 
phyliKoccus albus. and Streptix ikcus brevit,*' SurfKal ««' 
were found to be entirely umn|ured by this |ifOces». rrtn ^» i 

for a full hour. Moreover, they could l>e kej^l i^etmanrni.* m »^ 
bath without rusting Rubber tube^ x^-- • ' " -""'^ ^^ ^^hitwI by 
the treatment, but were even restored to ■ '**^ 

become a bit brittle 



Partial Dentures 



W. E. Cummer, D.D.S., L.D.S., Professor Prosthetic 

Dentistry and Applied Dental Physics, Royal 

College of Dental Surgeons, Toronto. 



(Conliniicd fioiii Maifli is.suc) 

Single Stud. 
A stud is a positive retaining device, used usually in conjunction 
w^ith other retaining devices located on the opposite side of the 
mouth, and consisting of a projection of slightly inverted cone shape 
of about 14-gauge (Brown & Sharpe), and about 3MM. long, which 
engages in a recess in an inlay, crown, bridge, dummy, or similar. 
(Fig. 19.) Is usually used with dentures having a loss of teeth on 





C D 

Figure 1!). — (a) Fi-ame work in position. (b) First step in removal, clasp- 
raised, (c) Second step, clasp free of bicuspid, piece moved laterally disengag- 
ing stud. (d) Framework. (N.B. — Insertion done in reverse order, stud 
placed first, then clasp.) Inlay shown im section. 




Bad. 



Fair 



Good. 



Figure lOA.— Proper shape of stud. (a) Cylindrical stud closely fitting: a 
cylindrical hole, does not allow -other side of denture to pass other retainers 
(Fig-. 19Bj without dislodging inlay, (b & c) Cone shaped stud. Fair only, as 
allows play when stud is not perfectly seated. (d & e) Inverted cone form 
good. No play in any position of stud. 

cne side only, and in conjunction with a rest or indirect retainer, is 
made to engage in a horizontal direction in the hole or recess, then 
on the other side with other attachments, such as clasp. Roach, 
Gilmore, etc., the saddle slipping home in a vertical direction. The 
removal of the piece is done in reverse order, pulled away part ver- 
tically and then horizontally, disengaging the stud as per example. 

Ring and Stud. 
In certain cases, such as those in which the attachment is desired 
on a shell crown, half hood, or similar comparatively thin covering 



OKA I. ill AL I H 



MS 



on the lingual side of a IcxaU. ihc proccM may be rc^cficd and a 
stud soldered tlu-icunlo ui>on which a ring rnay be engaged. 11» 
has an advantage also in the case of elderly |>erK>m and penom ol 
|)oor sij<ht. <naf)linK thrni more racily to "find the place.** but ihould 
not be used on inlays as ihr dislodging movement may be loo gieal. 
due to leverage. (Fig. 20.) 




»QA 



FlKure 20.— Jieverse of Klirur«> 19 

for thiM In n rlrur. incMi' ' 
M. (>. 1). or Kinilliir, foi 



Mliio 



DoLBLK Stud. 

In occasional cases studs may be op|)osed to one another to 

advantage, the appliance being removed by sprmgmg the fludb 

together, thus releasing the piece. A very good example » a Mm|4e 

iclaincr for an obturator (Fig. 21). in which two inlays vnlh recesMi 




Y 



yc^sj 




KIkuh* 21 — Stiou iiil: 

th. Tti..li' \ 



i>{ ttk< .kuihli 



i I liiiit tn All »h'.\ 



ff 



h IK. .■ I , i »;i.-i- I .»• I iiti IS . I 

were made on the lingual sides of both the ijp(K-r tir*' » * \ \ 

an arch of 14 gauge wiie lolletl Hal ami armed on ra. ' ^ 

stud, and with mesial and distal rests pre\enlmg i 
springs in and out. providing a very salisfaclofv allA tor an 

obturator, with the cutting of only two inlay ca\ ilie* ati itw ' ."v«! 
side of the* upp«T lust molar 

NhjiiAi. OH Ductal Stii* 

A very neat, efficient and sanitarv r- r..»,K n 

cases involving a space on one %ulr of ; ij^*^! tr<< ^ 

nl both ends t)f the space, and m\ the tilhet side a %\^<e wrth a f • 
at one end only, as per Fig. 12. A Mud is filled ill • meam»l m a^ 
with a rest on the first bicuspid, while a cla*p or MOMUr CAfAfe* ifw- 



146 



ORAL HEALTH 



opposite bicuspid. The piece is held down diagonally opposite with 
the distal stud and clasp, and the resultant force from the rest engag- 
ing in the inlay on the first bicuspid (left) presses the saddle firmly 
into position. (Fig. 22.) 





ST JO 

22-2 




ivifHU. 



/Nri£(?/vAU 



22-1 





22-4 



Figure 22. — Distal stud used in the mesial of an inlay. (22-1) Case with 
inlays. (22-2) Denture with ileft distal (internail) studs engaging in mesial re- 
cess in inlay, occlusal stud engaging- in occlusal slot in inlay in lower left 
first bicuspid toward mesial. (22-3) Piece in position. (22-4) Sectional view 
of left side of case. 

Compound Retention of Dentures (by Interlocking 
Devices of Two Elements). 

This class of retainer involves stationary fixed abutment to which 
one of the two elements is attached, by solder, such as crown, sta- 
tionary part of removable bridge, inlay with (or occasionally without 
posts) (for which devitalization is usually necessary to secure 
strength). Absolute parallelism is necessary in the case of the plati- 
num hood and split plate and its various modifications, the tube and 
split post, the engaging plates known as the Morgan attachment, and 
similar. 

Regarding this class of retainers accuracy is of paramount import- 
ance, and instruments for measuring the distance between the retain- 
ing teeth, and calculating from the depth of cavities necessary for the 
reception of the retainer as well as placing in parallel relations the 
retainers themselves for soldering as well as for holding the parts 
themselves during soldering, are available, constructed with all the 
care and accuracy of high grade mathematical instruments, for the 
assistance of the dentist in securing his results. While the study of 
the use of these retainers of precision (primarily designed for remov- 
able bridgework) and the technique involved representing the work 
of Peeso, Chayes, Ash and others, is particularly relevant to 
partial dentures, inasmuch as a large percentage of these depend on 
the mucosa for support with the teeth for retainers, yet properly pre- 
sented would fill a number of papers. Particularly for short spaces, 
with a tooth at each end of the space, the above methods produce 
results unapproached for neatness, sanitation and reproduction of 
natural contours in artificial work. 



ORAL HKALIH 



M7 



Fhc well krxnvri Koacli attac luiimi. (o(m%(Hi(( ol a t|>la tu^*^ 
slipping over a hall (Iig 22A). vvhitli tuA rr(|uiring ih* al>«oluir 
parallelism of the foregoing, yet. due to the contact of the two e\r 
ments being the line arouncJ the circumference of the l>all only, ma) 
be set with quilr sufficient parallelism without the aid of i|K>cial *'|if^*' 
I he action of the Koarh attachment is purely tr ^ tion. and abo 

allows for "settling" without placing an undue stz.. , Jti the t'-^i*** '- 

Iceth involved Carefully placed in the central |>o«ition in i; 





local Ktn •> 



m 



FlKuro 22C.- 
KoM wlrt*. 



Clnj«p fltmipnt of Gllmorr 



4m »aa 



brasure (l^g. 22B). in combination with similar or other means of 
both direct or indirect retention, a multitude of efficient, sanitarv and 
unobtrusive combinations may be ol)tained. Attention is 
articles in Oct . M)I5. licvicn*, i\ W Collrin. and Jul) lU'*t<u\ 
\ W. Koach. 1913. 

I he ('(ju.illy well known Cjilmore attachment (Fig. 22C). wh 
consists of the Mgauge wire with the s|)ccial (jilmore cla»f> fitting tl. 
^ulmils of some range of application. Some diurimi * ' 

'M lis use. as any unclur settling, due to the mt>re or le^s nun/.nt.i; ;••» 
lion of the wire, is apt to place an undue tipping ^t^rss . • iff ». ' r ? 
tooth. I his undue stress is more apt to come in 1 
Ciilmore wire is attached to single teeth With ca*r« in wfi 
wires span an intervening space between two lerth. « 
rach side of one. or one or more splinted I"' 'i 
lipping U'lidt-ncy is greatly minimi/ed In m 
largely avoided, provided the ridge is not too fla 
the saddles with the 1 4 gauge wire, held to the a 
only, reluming to mouth and p; down, dislodgmt; llw 1-4 *;-> 

wire low.ird ,\ position of riclge -ii.-- 

InDIRI.CT KlTKNTION 

May be spoken of as the u' ' n of .i * '' ^ ? 

that part of the denture to be i :. brt\* 

direct forms of retainers is mt« (F). s 



148 



ORAL HEALTH 



lending to seat the saddle more firmly in position. This scheme or 
system of retention may be used in a great number of modifications, 
chiefly in saddles with support at one end only. For example (Fig. 
23) : As it stands, there is nothing to prevent the saddle dropping 
down, but with the addition of a "rest" (Fig. 24), the slightest tend- 
ency for the saddle to drop results in an upward pressure of the *'rest,** 
the piece being held in the centre line by the Roach attachments, and 
thus with adjustment, an unsupported saddle may be made to press 
up into its position even in excess of that pressure really required. It 



y^^'""^!^ 


i=_ 


m 


/frf f}V 

l^ =:^ 


) 


v^:^:i^^^== -a:^^ 






WITHOUT DENTURE 


DENTURE 


(UPPER) 


WITH DENTURE | 



Figxire 23. — Indirect Retention. As constructed this case would not be a 
success. Nothing' to prevent saddle from dropping- at rear. 





#% 


^k 


/CTj >^ RoicN ^^TxA 


\\^^ —^J 






WITHOUT DENTURE 


DENTURE (UPPER) 


WITH DENTURE 



Figure 24. — Indirect retention. With the addition of rests (in centre cut) 
any tendency for the saddles to drop is instantly checked by the rests touching 
cuspids. (Fig. 25.) 



IT 



^ Lever Ist Cla55, Ex Crowbar, .shcars. 



w 



r 



jt i-EVE«. 2no CU\5S. Ex nut CRaCHEK. TfiinBOAR.Q 



JOC /.EVER 3ro CkASS. E)i HW-IAH Jav. 5<iQAR TONQS. 




ONE HALF LIWOUAL VIEW OF ABOVE. P. INDIRECT RETAINER 
OR. "^EST"' ACrWC THROUQH A OiUBCT RETMnER ( PJ ReSULTS IN ifPWARO MOVE. Vs/. 

Figure 25. — Indirect retention is an application of the lever of the first class. 
Lower cut represents a lingual view of one half of case in Fig-ure 24. The piece 
is held in the centre (F lower cut) by the Roach attachment. Any downward 
movement of saddle is prevented by rest passing forward and touching cuspid. 
Therefore the cuspid, acting on the rest might be considered as the P, or 
power of the lever. The Roach as F. or the fulcrum, and the retaining or up- 
ward reaction on saddle, as W, or the work of the first class lever. See upper 
drawing for levers. 



ORAL HEALTH 



149 



may be riolrd thai ihr rationalr is a modificAtion of ihe \r\n ol the 
first class, in wlucli in this particular inUance the |k>v%'^' " 'v (m. 
likened to the "rest" pressing on the cuspid, the fulcrum. * 

attachments and the work, the resultant force which tendi lo pr«i 
the saddle firmly in position Herr ff)llnws a number ol eiamplcs ol 
cases in which indirect retention is li^^d It will be noted ikal only 
two direct retainers are used in all i<isrs, and that ftkclrion con<r\K 
tion in all cases away from the gingival margm it recommefKled 
(Figs. 25. 26. 27. 28.) 

Class A Dikk r Kktainrrs Dugonally Oppositc. 



x^^ 


r^l^ 




-f y^ 




n-^ . 




/JTV^^ 


id/^ 


Mrlain«r ft 


KiJ^l^^K 




I>|r#«'t TV\%\T\rT 9 




iXSu^ 


V \G^ 


*s^ rj^l\ 




ihACcmAllir av0»* 




Ir^H 


N. Y(^]]qV 




^s. TiqJN 








fjjl 


^h\ 




NQ 




€tr 




I 


^ \ 








— ao 
ly OPT- 





l'ii:u 



lnU> with 

Kccct* 

(or 

UUIal stuil 





WITHOUT Ot NT UHf 



l>l»lal 
siuJ ♦ ^ 




DINTUHI UPPId 






T •« D I • • - • » 



'ollilll 



til. I w- 
h.'l.l in 



th»«« 




M I M D U T I N T U P • 



A3.— «'"«i 

nri«t cut I 
dlrrrt 




01*1 uai jrri 




«ita •«»l«*t 



30 ORAL HEALTH 

Class A. — Direct Retainers Diagonally Opposite. 




WITHOUT denture: 



Indirect 

Retainer Roach 

Split Tube 




Interproximal 
Qasp 



DENTURE (UPPER 




WITH DENTURE 



A3.^ Condition as shown, similar to A2. except bridge. Preliminary work be- 
fore impression core under bridge, and inlay as snown. Framework as shown 
(note interproximal clasp in right hand drawing). Insertion and retention, 
interproximal clasp first. Roach attachment next, through these indirect re- 
tainer acts as case A2. 




^without dcnture 



Clasp 




Inteiproxfmal 
Clasp 



DENTURE UPPER 




WITH DENTURE 



A4. — Condition as shown. Preliminary work before impression making, in- 
terproximal clasp from wax pattern applied directly to teeth. Framework as 
shown. Insertion and retention, interproximal clasp in position first, then 
clasp, indirect retainer through these diagonally, opposed retainer E acts as 
saddle, similar to case A2 and A3. 




WITHOUT DENTURE 



Roach 
Split Tube 




DENTURE UPPER. 




WITH DENTURE 



A.5.— Condition as shown. Preliminary work before impression, inlays com- 
plete (without Roach balU with sprue left on. Framework as shown. Inser- 
tion and retention double stud in inlays first, then Roach tube in ball. Anterior 
stud indirectly retaining saddle through posterior stud diagonally opposed to 
Roach attachment. (P. S.— Might be considered as a class B case, considering 
the anterior stud as a direct retainer diametrically opposed to Roach attach- 
ment. See class B.; 



OK Al. HhAL I H \6l 

Class A. Dikf.c r Kktainlks Diagonally Opposrri 




^Hil lubr 





HTMOUT Dl N T UHI 



ULNTURf UPPiR 



>ITM OiaToPI 



A6. — f. .«. n I'j. . «t>rk 

nut Mtud. but Wlf Mlirur. 

lion And rriintidii indirtTt rctiiiner undrr dlatal iitud. Mud 

ftourti Npllt lub«« ov» r ball. The direct rctn'- -- •'• " ^ .m.-n- »i>'i 

the stud in the llntnitil Inliiy on molnr act il »ar domm- 

ward movetiu-nt nf lh<- ^:iddle which In • • ntarwmmmt 

i»r th«- in(lir«( t Mialntr i- (luM-kefi b> tht i»olar lalAjr. 






WITHOUT DflTURI 



OfNTUHl UPPIR 



IIT M 01 ■ • »•• 



A?.— (*nndltlon nn Khown. rrellmlnnry work brrorr 
uji iihown. MprueM uncut Framework u« whown ' 
directly to plm i . the iMclu>i«J »«ml tndlrectiv 
throuKh the Itonwlll clu^p. :i' 
that the uptx*' rluht nrj«t !■ 
niANt lent Ion with the mucomi under the «iddl«. 



.' thi 




iTm;^UI DIRTURI 




DIRTURi urria 




•iidliltm tin nhown. lilnti 

work 

In wax onl>. to divide pre^Mure i 
tent Inn. dln-ctly to place, rlt''' 
UiK one another thr«Hivh the 



«ita eiajRt 



52 



ORAL HEALTH 



Class A. — Direct Retainers Diagonally Opposite. 




WITHOUT DENTURE 




DENTURE (LOWER) 



Indirect 

Retainer, 

Rest 



Clasp 




WITH DENTURE 



A9. — Condition as shown, (See Fig. 22.) Preliminary work before impression, 
inlay with mesial lecess on molar inlay, and inlay with slot on bicuspid, as 
shown. Framework as shown. Saddle on left side may be omitted if desir- 
ed. (See Fig-. 22). Insertion and retention, distal stud in inlay first, occlusal 
stud next, clasp last. Occlusal stud indirectly retains saddle on opposite side 
through diagonally opposed direct retainers, viz.: distal stud and clasp. 




Occlusal 
Stud or 
Rest 





WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



AlO. — Condition as shown. Preliminary work before impression, inlays as 
shown, with uncut sprue in position. Framework as shown. Insertion and re- 
tention, directly to place, diagonally opposed, Bonwill clasps retain directly, 
mesial and distal wires from left cuspid under saddle indirectly retain right 
saddle and weight divided between teeth and mucosa. 




'Occlusal 
Stud or Rest 





WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DEN1URE 



All. — Condition as shown. Preliminary work before impression, inlays as 
shown, with uncut sprues. Framework as shown, swaged cup bearing Dentsply, 
Goslee or other crown. Insertion and retention, stud first, balance directly to 

place. Indirect retainer, through Roach attachment and stud reacts on crown 

with double occlusal studs. 



ORAL HKALIH 



153 



Class A. Direct Kftainers Diaconault Opposot. 





Stwi 




WITHOUT OfNTUHl 



OINTURI UPPIM 



WiTm oiaT<J»t 



nhown, H 

Stud Mr^t, i>iiinif .|;t.. u\ n> i>. 
tain nnt* iinothtT throuKh th«* dl 



Class U. [)m\ a \ \<\ wiwns Diamf rwirAi i.y Oppo^rrr 




''V \ \f l*T,|- 



!• mm •• J I < 1 



f'S 














WITHDUT Ot»«TU«l 


01 nTum urn ■ 


m ■ t m OI«»W»« 



Itl JNiiwIltlon 

llllpl •■MfiloT- ^' 

ifhiiwn. I 




02- •<'omlin.»n im nhown I" 

fihowii ' 
on <*uddl> 



54 



ORAL HEALTH 



Class B. — Direct Retainers Diametrically Opposite. 






WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



B3. — Condition as shown. Preliniinai>- woi-k before impression, individual 
impressions, etc. for clasps. Framework as shown. Insertion and retention 
directly to place. Indirect retainers react on anteriors, saddle thi-ough diaine- 
trically opposed clasps. 






WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



B4. — Condition as shown. Preliminary work before impression, two inlays. 
Framework as shown. Roach split tubes mounted on 14 gauge wires in turn 
mounted on indirect retainers. Insertion and retention directly to place. In- 
direct retainers react on anterior saddle through diametrically opposed Roach 
attachment, similar to B3 and B5. 





Retainer 




WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



B5. — Condition as shown. Preliiminary work before impression, inlays as 
shown. Framework as shown Insertion and retention directly to place. In- 
direct retainers react on anterior saddle throug-h diametrically opposed direct 
retainers, (Roach attachment) similar to B3 and B4. 



ORAL HKALIH 155 

Class B Direct Rftainkrs Diamlirktally Opposirt. 



Iriljv Mil' 





to inL.1 iijr 




WiTHlljr DJNTUHI 



OftiTuHi urpia 



iiTH Of«'j»« 



IW. — rundltlon a« *hown I»rrllmlnnr>' wnrk h^nf^ !nv 
ithown. FriuiK'Work '■ n Kx' »a4 •i»4 vu*. 

nllKhtly Maiiencd. h' 'iinu«| ..t .wn !• '-^ v ^. 

In middle nkftch. Innertlon and retention. One i. 

Into plAriv Indirect retainer renctji on iwiddlr thrtKiKM r.jr,. 






• l»4 «T »l >• 



WriTMDUT DflTUHl 



DIMTUMI UPriR 



miim ot a'a'c 



117— Cnndition. cleft piilnte, nil te«»lh I 
IniprcMHlon, Inlnyfi am Hhown. Kramework a 
inminted «n bar 11 irauuc ullirlitly rinttened ; 

and I • • 
tatnci 




> S|.,l 



WITHTUT 01 '•'U"! 




211 K.) I n Mr r turn nn«l 
ItiuiwIU c1aj«|»* ^••' 



156 



ORAL HEALTH 



Class B. — Direct Retainers Diametrically Opposite. 






I 



WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



B9. — Condition as shown. Preliminary work before impression, forming 
clasps from individual Melotte's metal casts. Framework as shown. Distal 
saddles joined either by bar or plate, depending on area required. Insertion 
and retention directly to place, anterior and posterior saddles indirectly retain- 
ing one another throug'h clasps. Direct retainers diametrically opposite. 




Indirect 
Retainer 

Strip , 




Roach 
Split Tube 




WITHOUT DENTURE 



DENTURE (LOWER) 



WITH DENTURE 



BIO. Condition as shown. Preliminary work. Inlays as shown. Frame- 
work as shown with 18 gauge platinum and gold stud touching distal of bicuspid 
inlay. Insertion and retention. Strips react on saddles through Roach attach- 
ments. Not recommended for similar, upper. 



Splint 






WITHOUT DENTURE 



DENTURE (LOWER) 



WITH DENTURE 



Bll. — Condition as shown. Sound teeth at end of series not attached to 
splint. Not desired to cut these. Preliminary work. Splint from left cuspid 
to right first bicuspid, latter splint end to bear Roach ball. Framework as 
shown. Roach tube set on 14 gauge wire or lingual bar. Insertion or retention 
directly to place. Indirect retainer reacts on saddle through diametrically 
opposed Roach attachment clasp. 



OR A I UKAl/I H 157 

CLAhi li DiKKCT KkTAINERS DiaMFTRKTALLY OpPOSfTt. 




i^*«atn«' ' 



iU-.. 




•il^ 




WITHOUT DflTUHf 



OiMTUX i.O«l* 



T" Df«'<»( 



MI2 — c*ondltion tin nhrmrn (•«• PI*. 19). Rrid«» In pUr* I' 
lH*rore linpr«*»j4lon. Inlny im iihown. Kr-- -^ ' ' mt^r: . >r> »r i 

retention i«tu<l In Inlny. then rla^ip. Indlrr* * uddi* thtt 

dlumetrinilly opponvd rlaup nnd iitud. Dlr«ct rvla.i»«r *i.Aiu»(f mtaOit flppoaM* 






WITHOUT OINTUHf 



D:<»TJ«I lOOrf" 



HI 3. — i!*ondltlon badiv bri>krn down lowrr l»ft flmt mntT r.- 
I'ri'llnilniiry work before ImpreH^lnn. l*ra«rn. for molar 
with rtnir fltthiK In ntatitUMry ntud on m«>lar rrown i 
rtnic over Ntud Mmt. then riaiip. Clajip nnd rinc and -' 
Klir. 20). Indirect rvtnlnvr mirtii on Middle thrmich thr»«. 




&'^ 



Slot 



WITHOUT D I W T U H r 







• »l T J • I I • f ■ 




( • • C 



HM .>4^ondlllon a* nhown 
wliown nnd with unmit iH>rti- 
Indirvrt retrtlner. In — * • 
rrnctjt on utiddle thr 



!• .! 



»rv work twi 



I A ' > IkA t . 



58 



ORAL HEALTH 




WITHOUT DENTURE 



Stud 




'Indirect 
Retainer 



DENTURE (LOWER) 




WITH DENTURE 



B15. — ^Condition as shown with so-called Hygiemic bridge, I'emoval not desired. 
Preliminary work before impression, cores under bridge, drill hole and fit 14 
gauge wii-e. Fi-amework as shown. See last chapter of this article. Inser- 
tion and retention. Stud in hole in bridge first with indirect retainer under, 
then clasp. Any upward movement of saddle arrested immediately by indirect 
retainei- under, then clasD. Any upward movement of saddle arrested immedi- 
ately by indirect retainer under bridge, acting- through diametrically opposed 
stud and cJasp. 

Class C. — Direct and Indirect Retainers on Same Side. 




C Gilmore 
Attachment) 



Class C. 

Direct and indi- 
rect retainers on 
same side, usually 
wi'th short series 
of teeth on one 
side of mouth onl>' 
and indirectly re- 
taining- the balance 
of saddle area. 



Figure 28, Class C. 



EXAMPLE CASE, CI. 
-Indirect retainers on same side. 



Bridge 




WITHOUT DENTURE 




,_ilmore 
Attachment) 



DENTURE (LOWER) 




WITH DENTURE 



CI. Condition lower left cuspid and bicuspids standing-. Preliminary work 

before impression, splint these and add Gilmore wires. Framework, saddles 
joined by bar, carrying two Gilmore attachments, and indirect retainer. Inser- 
tion and retention held down directly by Gilmore's indirect retainer holdmg 
remote parts of saddle. 




C2.— Condition, upper right central, lateral and cuspid standing:. Prelimmary 
work, splint these and add Gilmcre wires. Framework saddle joined by bars, 
indirect retainer added to anterior bar, Gilmore attachments under. Insertion 
and retention. Directly by Gilmore, distally by indirect retainer acting through 
Gilmore attachment. 



ORAl. m.AL I M 



159 




ITMOUT OINTU*! 




oiwTum U^riB 



-CVindltlon mime n« 02, vxropt torrr of 

tt.. «....lt. I •. ..I . !..,•. .. . U...L , 




wiTm ora.jvr 






KkcAKDINC THK 1*051 HON OF Kf3T. 

Kulr (A) I lir greater the distance of ihr "rr»t" or incjirr<t 
rolainrr from the direct rrtainrr or an imafcinary I"— •■"•;• ihe 
direct retainers, the h\ss the strain on the retainer or r- . > -J x\y 

tooth or teeth supporting the direct retainers. Ilic resultant force 
is only the weight of the saddh\ plus shghl gum rrMhency. Ir%.» fiK 
tion. ( The "rest** and saddh* being e(|uidi5tant from ihr dirr^ * 
lainer or retainers.) (f'ig. 29. A. B. C. D.) 

(B) Should the "rest" carry the weight of maslKalKXi. il thoulcL 
as a rule, he seated in an inlay. (Fig. 4.) 





•1^0 



^^'^(r^. 




« O I • ^^ • t 



WITH, TUT OINTUHI 



I N T U H I u r »■ I N 



on 

diii-rt 






I I M .)U I L) I N I U « I 



ocaTuai urrca 



•■ •■ Ol*^**' 



KlKurt* 
« lojMT to 11. 
purnllH llnr«. sniiip i< 

FlKuro 



160 



ORAL HEALTH 





=r^. 



3ikCj 




WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



Figure 29C. — Showing another less favora;ble form and position of the indirect 
retainer even closer than 29B to line of direct retainers, also shown by separa- 
tion of dotted lines. More leverage than preceding dsign, and confind to one 
tooth only. 




^T*/f> 





WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



Showing another form and position, least favorable, of indirect retainers 
(strip of metal acting on bicuspid inlay;, almost in line with line of direct 
retainer. Reaction also confined to one tooth only. 

Position of "Rest." 

(C) — Should always arch over the gingivae. (Fig. 29E.) 

(D) — A slight advantage, due to the elimination of the elasticity 

of the central bar, may be secured by placing the indirect retainer on 

the same side as the saddle. (Fig. 29F.) 



1/ 1/ 



Figure 29E. — Indirect retainer should arch over gingival margin. 




Roach 
Split Tube 




Indirect 
Retainer 



Stud 




WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



Figure 29F (a). — Design showing indirect retainer on opposite side of case to 
the saddle. 



ORAL HI.AL I H 



161 




WITHOUT DENTURE 



Indirect 
KcUintff 




•'tttd 



OENTURL UPPfR 




>ir H Of « V j»( 



FlKure 39 F (b).— r>e«iim for juime caii«. nhowlnc Indlrvct rvtatevr oa m 
wide. Hlixht iidvantnicv htrr In rllminntlnff r|«jit' - . ^ - . ^^ 

Indirect retainer. Thlw arranKement (naddle ar m 

Mldei In deittrable, provtdod the saddle and natural t««li» aUo« ol U. 



FJKUr.- 29F.— An In- 
the .Hprlnify of an Int 



loaa d •rArtoflNT lliraucH 



I I < HM( AL PK(X K.DLRK 

As may he gatlurrd from the foregoing, ihr drsign of a rr«Uy 
fanitary and mechanically rfficicnt pircr is a mnltrr for COQtiderablr 
rrflcction. and in many instances calls for a set of skiagraphf ol the 
whole mouth, careful root and pulp canal treatment, ritractiofi ol 
doubtful teeth, and then a pair of study models. In addition lo the 
mechanical consideration suggested in the foregoing. rmg ioCO 

the design of a p4irtial denture, the element of the |m Iqm ol 4k 

tooth or teeth should he kept in mind, and the piece cJ« , d accord- 
ingly. I In- design of the denture having been worked out. all CfO%imt, 
posts and cope (without |>orcelain). inlays (leave »|>nie on for draw- 
ing from tooth in impression) and \arious other element* (|»*efeTaWy 
without dummies) should be completed and placed in the nnxith. 

Trays. 

From the study model a slock tray of Greene- Kerr, Su} 
or any of the newer patterns, designed lo avoid miwcle aclMja, 
may be adapted, or a special tray casl in pure alummum m 
each case, preferably with lietachable handle, the wa% |*allefn for 
which may be formed from the study mo<lel. or fiom model ol ifn|wr» 
sion compound rapidly obtained by pushing softened "»• 

pound into previous denture and inverting on wel gla** »!,io. cmjung 
and sep.irating. 



(«-ii«H-la4*4 la May »«»•»* 



Dental Service in a Toronto Orphanage 



By Arthur Day, D.D.S., Toronto. 



THE children of the Sacred Heart Orphanage, Toronto, have 
been receiving dental treatment for about tvv^o years, and there 
has been a marked improvement in the health and general 
efficiency of the children. 

The orphanage contains over two hundred children. Their mouths 
are examined at least once a year, and the dental defects are then 
corrected with as little delay as possible. The only work outside of 
these regular periods is when a child is admitted or one of the children 
suffers toothache. This latter contingency, however, very seldom 
arises. 

Notwithstanding the fact that it has been only possible to make a 
yearly examination, there has been a marked improvement in the 
general health conditions of the orphanage. Of the two hundred and 
twenty-five children, the girls and boys are in about equal number. 
Their ages range from six to eleven years, and they both live and go 
to school in the Institution. This latter fact makes it possible to keep 
the matter of oral cleanliness thoroughly under the supervision of the 
teachers. 

The Superioress reports that since the children have been getting 
their teeth attended to their disposition, as well as their general health, 
has been noticeably better; the children have lost no time from school 
through toothache; it takes less time for the Institution to have the 
dental work done; and, in the opinion of the Superioress, it is an 
actual economy to maintain a free dental clinic. The Sisters in 
charge of the classes advise that almost without exception the chil- 
dren become more alert and seem to learn more quickly in school, and 
have also noticed the general health improvement. 

The following cases may be mentioned in particular: 

Case 1 .^ — Madeline L., age thirteen years, considered deficient; 
placed in private families at two different times, but in each case was 
returned to the orphanage being considered deficient. She has since 
had her mouth put in a condition of health, and is now quite up to 
standard in school, and competent for her age in performing her 
duties about the orphanage. 

Case 2.- — Annie W., age fourteen years; was never even con- 
sidered as sufficiently advanced to place in private family. Since 
having her teeth attended to she is very much improved in class and 
especially valuable in her duties about the house. 

Case 3. — Hazel and Francis J., ten and eight years respectively; 
before dental attention were always complaining of illness, losing 
much time from school; were anaemic and lifeless. After dental 
treatment these children brightened up, were ready to play and romp 



ORAL HLAL I H 163 

at recess time; took an interest in their sludjcs and trcncd l&e dbfcf- 

ent children altogrthrr. 

Case 4.— Joseph and James H . age eight and tii ye^n rr«|icc- 
lively ; were miserahlr, puny and pair farrd and subject to toocKachc. 
After dental treatment a marked diffrrmrr was noticed m both 
children. I hey now look much hritrr and brighter, and arc mere 
interested both in class and play. 

I \\r or|)hanage Nurse makes an interesting re|>ort. inlimaling that 
up lo the limr the regular drrital inspection and treatment w.i ♦^ 

out there were regular epidenncs of coni •-m....% diseaMn .-...lei 
Fever. Diphtheria. Measles, etc.. but prin Di|>hlheTia SuKe 

the moulh.s of the children have been cared for there has not been ao 
epidemic of any kind and not a single case of I^iphthrria or Scarlet 
Fever. I he Institution has been o|>erating for twenty h\e ytMt%. 
and never before in its history has it passed through a year without 
Diphtheria, and at times has had Diphtheria in the or|>hanafe con- 
tinuously for twelve months. Consider this evidence. Fwenly fi^e 
years with Diphtheria epidemics and without rrRular denial treat- 
ment: and then teeth tilled, roots extracted, mouths regularlv 
brushed in the proper manner, and not a single case in two years. It 
this a coincidence, or is it proof of the necessity of school dental 
clinics? 

I his report in connection with the Sacred Heart Orp*--- ^ 

particular \alue. in that it is supplied by those ha\ing • 
children during the whole twenty-four hours of the day. a i mtweff 
the [)ossible suggestion of the sceptic that the improvement in health 
could be attributed to some other changed condition in the children'i 
home life. I hese facts have been re|>orted to me by those in charge 
of the orphanage, and not bv enthusiastic meml>er» of our own fifO- 
fession I have refrained from adding my own of>ini«i < ^kaL 
Fb AI.IH would not be big enough to hole! thrm in the |>fe»ent rnlhu«i 
astic stale of my mind. liesides. it is better to h^^- '-•-••»• •■ - *> at 
the above, from authorities other than practising <; *k 

louder under such circumstances lo other governing b 

I desire also to pay tribute to the assistance rendeieil \*\ ■ 
ciptil Dental Clinic and to the unvarying courtesy from Dr. i>«^n»«rii 
and his co laborers. 

In conclusion. I only wish to state that children can learn to bfuih 
their mouths as well as adults can; and that the children at the 
orphanage, as a class, brush their trrth as well a* any group of m\ 
private patients, and taken in(h\idually there are some who ^V* * 
much better. 



Dental Clinics for the Children of New York 



Matthew Carney, D.M.D., New York City. 



WITH a constantly increasing number of ailments directly 
traceable to defective teeth, the actual need for free dental 
clinics for school children is not only conceded by leaders m 
the medical profession, but is fast becoming realized by the municipal 
health and educational authorities and the public in general. Even 
the taxpayer upon whom the burden falls, in the case of free dental 
clinics that are supported by the municipality, is beginning to reahze 
that preventive medicine and preventive dentistry are not an expense, 
but the essence of true economy. 

If there exists any question as to the actual value of institutions 
founded to arrest dental decay and give good masticating apparatus 
to the children, one needs but to look at the results accomplished by 
our dental clinics in New York. 

The dental clinics were organized in January, 1913, by the De- 
partment of Health of New York, and associated with the Bureau 
of Child Hygiene. There were six clinics opened and a staff of nine 
clinical dentists and one supervising dentist installed. These men 
were selected after a competitive civil service examination that gave 
them the rating and salary as men of their grade in the medical 
profession. In the examination, experience counted 40 per cent, and 
the theoretical paper 60 per cent. Three of our clinics are equipped 
with two complete outfits and three are single clinics. Each clinic 
has a trained nurse in charge, whose duty is to attend to the steriliza- 
tion of instruments, assist the operator at the chair, and perform the 
clerical work. Associated with each clinic is a school nurse, whose 
duty it is to bring the children to and from the clinic, investigate the 
cases, and ascertain whether or not they are proper patients for 
charity treatment. The clinics are open daily the year around, from 
1.30 to 5 p.m., and on Saturday mornings from 9 a.m. to noon. 

The equipment was purchased on competitive bids, and the cost 
of installing a complete dental outfit in each clinic was approxi- 
mately $775. When these clinics were first started, we accepted as 
patients all school children up to 14 years of age. This plan was in 
operation up to the opening of the fall term of 1913. Careful obser- 
vation of the clinical work performed in this country, and the statistics 
compiled by foreign clinic committees, convinced that the most good 
could be accomplished by restricting the age limit to eight years, 
accepting only members of the first and second grades, and thereby 
striking at the root of the evil, and putting the child's mouth in good 
condition for the reception of the permanent dentition and preserve 
the first permanent molars and corner-stones of the dental arch, before 
they had become too far gone. 



OK A I. HLAL I H I65 

riiis plan was adopted with gratifyinx sw - 
to treat more childrrn than ever before; for lh« 
to such an extent where they rec|uirrd long trcalmmtt for 
pulps and devitali/alion. When we found the trTn|>orary trdh m 
putrescent corjdition. they were usually »o far gone thai eitractioo 
was the most advisable method of prcx:rdurr. 

'T*hc scof)c of work fierformed m the cimics is limitrd We do 
extractions, using a local anaesthetic where mdKalrd. plaslK filluifi, 
that is. cement and amalKam. cleanmgs and treatments I'hr (irnml 
registrations in our Puhlu .Schools is approximately 9Sf>"'"' md d 
these children at least 600.000 are in urgent need of drn? itmrnt 

Ilie number of clinics is so small that we are unable to befm to 
cope with this tremendous problem, we ha\e simply bla/ed a trail 
through this jungle of decay. Since the opening of our in 

January. I'^l 5. we have of>erated on approximately ?*""*) . ruiairti 
About U).000 have been discharged as cured. (i.(M>* - drotx^,! 

from our records for various reasons, chief among these are iiH 
bilily. failure to keep appointments and removal from the cfelnct. 
\X <• ha\e inserted over 150.000 filling*, and extracted upward oi 
40. ()()() teeth, of which number over 33.000 were deciduous pAeTT 
child that has attended our clinics has had the teeth thoroughly 
cleaned before being dismissed. 

I he work that has been done has demonstrated it* value in many 
ways; it has awakened the public to the fact that the ter'' • ' ' 

are important and have a decided influence u|>on the , .. 
mental development of the children It has reduced the : 
absentees in the schools, and enabled the child to de\ole his trn^e to 
study and making his promotuMi more certain, and ha< ' * * 

the cost of education, for the money required for th'* • .. .lii. .• .^^ 

the children left behincJ each year is a very large ai Il>e old 

adage of **an ounce of prevention being worth a |wHjnd ol cure** 
must have been written by a dentist 

1 he single unit idea that has been adopted in \r%% ^ tick i« ih** 
solution of the dental clinic prt>blem it i* far mote •«••'• --*^' ♦ ^ 
more eflicient than having one central clinK Iliese %i 
situated as they are in the hearts of congested »choc>| tk- 4fe 

easier of access and better palroni/ed than if the of 

the citv were being carried on in one institution refmitr tr«jm "»•■ *«H|. 
gested «ireas. 

Ilie preventive side of dentistry should constantly br in|«i'tMc| 
upon the fertile mind of the young |>alienls Iliey iliould 
talks on blushing the teeth and the advantages of a f»o**li» 

e\riv lime thev vi^it the i Imu . and lhr%r inslructiom tKoyuJ "»• aw yl * 
hed .ind enforced in the class rtH>m 

Tlie supervision of the work in the munKi|^l clinics is an Mnfwlafli 
factor. Ilie various lines of treatment to be follov»-ed Ml the ttwtrt- 



166 ORALHEALTH 

tion of the varied conditions falls entirely upon the supervisor. He 
must see to it that the work is uniform throughout the city, and that 
each operator is both competent and conscientious. 

In January we intend to open up five clinics in the school buildings. 
We believe that this new departure will have many an advantage to 
offset some of the objectionable features of a general dental clinic in 
a Public School building. Suggestions and instructions given by a 
competent dentist, aided by the invaluable co-operation of the teacher, 
will do much toward having a path through this wilderness of decay. 

I believe that the dental work should be both corrective and pre- 
ventive, and that both branches should be performed in conjunction. 
After the mouth has once been put in good condition, it should be a 
comparatively easy matter to keep it so. The dental nurse can follow 
up these children in the class-room and give them their future pro- 
phylactic treatments in the mornings when the dental clinic is unoccu- 
pied by the dentist. With the co-operation of the teachers in the 
class-rooms and the mothers in the homes reconstructive dental work 
should be reduced to a minimum. 

If precaution be taken to see that proper habits in the care of the 
teeth are formed during the impressionable age of childhood many 
of the ailments that are directly traceable to defective teeth will be 
avoided in later years. 

We have merely laid the foundation for this work, and the results 
lead us to believe that we have started right. These clinics are an 
insurance against the spread of the diseases of childhood, and aid 
materially in the making of better, healthier and more useful citizens. 



Periodontia for the General Practitioner 



By Paul R. Stillman, D.D.S., New York City. 



FROUDE, the philosopher, has said: "The knowledge that a 
man can use is the only knowledge that has life and growth in 
it, and converts itself into practical power. The rest hangs like 
dust about the brain, or dries like rain-drops off the stones.'* In this 
sense, it should be impressed on those among you who have not yet 
grasped the fact, that pyorrhea, that "thorn in the flesh" of most 
general practitioners of dentistry, may, and should be treated success- 
fully by all. 

To acquire the necessary knowledge on the subject, and the tech- 
nique in the use of the proper instruments needed in its surgical treat- 
ment, seems to me to require no greater gifts in dexterity and applica- 
tion to an idea than does the problem of the cohesive gold foil filling. 
Remembering the first agonized attempts of the freshman in college, 
in this comparison the cohesive foil filling is, to my mind, by far the 
more perplexing. 



ORAL HI \I I fl 167 

It \s the speaker's belief that the »ccre< mind of the clrfit«l [inliiLin 
at larK<- is one of fixrd pessimism, when brought face to face w«h ike 
subject of successfully treating typical trxrfh shaking. pi»-flo%nnf 
pyorrhea; that a despair enters the mind of the olkcr%nte capable 
dentist, to whom all other branches of our work frrm tirople m com* 
[)arison. this is not as it should be I he ducernmg fiubbc m now 
demanding relief, and its enqinniiK mind will lead it to placr^ where 
relief may be obtained. I.\ery dentist 'hould be ab|r » -- • '"^ 
percentage of cases coming under his o()fer\atian. fil 

development of the disease in all. fhosr men who have already 
taken up the work ha\e found, in their own pr a HUbcienC 

number of cases to employ their time and enhance hinr uicoaiei %rilh- 
out recourse to acti\e competition in ac(|uiring good cams for treat- 
ment from other sources. New cases will come to all who demoriAlrate 
their ability to obtain results that are satisfactory. 

So many and <o \arious ha\e been the essays and |»a|irr« on the 
subject of pyorrhea that lo attempt any reMew of them would ''•^'•l lo 
confuse the mind. Much has been written in the past, that ' a 

only of hi'torical interest. My advice lo anyone wishing lo imfifoire htf 
understanding of the present state of scientific '" ' '. is to ' ly 

read the wrillen works of Dr. I hornas H. H.ii>/ f M- .♦. 

His writing conlamf fewer utterances of doubtful s.n .• • i • at 

is sound, practical and true than those of any other man who has 
written on the subject. All that Dr. Hart/ell has given ut %nll be ol 
[^resent value to men who desire to increase *' ' j und m 

literature based upon research, scientifu .ill\ enmnfe- 

hensively f>resented. 

I ho.se who have studied the etiology of pyorrhea, a* il a|>|>eared m 
the literature of dentistry in the past, will remember, that in eariicf 

days, opinion divided itself into two •• ' ' . \i/: (I) '»>-'- »^'*^-^ --'^ 

sideied the symptoms as l(Kal manif- ^ of an ui>» 

disorder, due. perhaps, to faulty metAl>olism. dialnie*. ufK acid dwi 

thesis, etc.. and who looked to ihe pharmacopia for relief and lo the 

forceps as the onlv sur^ual pr«xedure th.r ' . . i i.. 

and (2) those who treated the di^rtisr ._ 

a purely local infection of the pendenlAl membrane, cau^rtl b\ » rtf am 
exudates or concretions known as tartar, the remo\al of which alwar» 
improved the symptoms. 

In refutation of the first school, recent in\-»»'- »•— * •" »***• **^*^t"».> 
logical field ha\e brought out the fact that iw > 

known to mankind are of bacterial origin: and that, inilead o< 
diabete?, uric acid, etcetera. l>eing the cau«et ol : *. *•«• b«^ 

every reason tr believe that manv of the^r stt: - ^" "* 

fact, dependent on just such it»ndition* .*♦ 
produce a fcKus of bacterial infection 

llie pioneer* of ihe second school, re|irr*rnieti » 

F^iggs and his followers did effect cure* f^areninrn.^i!). n p ol 



168 ORAL HEALTH 

interest to note that Dr. Riggs gave his first public clinic and demon- 
strated his method of surgical treatment in 1869. Up to the present 
time, some of the ablest minds of our profession have doubted the 
efficacy of the surgical method, and have given ear to those who 
attempted to teach easier ways and methods; but the truth of Riggs' 
idea stands vindicated, for to-day every specialist who is treating the 
disease has to depend upon surgery for success. 

Most of the cases that come to us are the result of years of neglect, 
personal neglect on the part of the patient, and neglect due to indif- 
ference and lack of ability on the part of the dentist. The disease ii> 
usually in an advanced state when relief is demanded, and much 
permanent havoc has taken place, extraction often being the only 
remedy. What misfortune, and only neglect as reason for it! These 
shaking teeth stand like dilapidated tomb-stones in memoriam of our 
deficiencies as members of a learned profession. And, saddest of 
all, while our watchword should be conservation of the teeth, in this 
most destructive disease that attacks them, we have done so little to 
prevent or cure. 

That we may get down to a working basis, may I present to you 
my line of procedure in handHng a case of pyorrhea? 

After examining the whole oral cavity, a record of the conditions 
as presented should be made. Explore all deep pockets to ascertain 
the extent of the lesions. Any dental work presenting such condi- 
tions as over-hanging margins, lack of proximal contact point allowing 
for the impaction of food in mastication, or unnatural contour of 
fillings or inlays should be corrected or removed from the mouth, no 
matter how recently the work has been completed. Let me impress 
upon you the importance of making records of all examinations. 
This is a necessary procedure in diagnosis and a particularly valuable 
asset in study. 

The beginner may not get far beyond the facts that a patient has 
agreed to pay a certain sum of money, that the diagnosis is pyorrhea, 
and that certain individual teeth seem to be beyond the aid of mortal 
man; but, in great seriousness, I advise that these simple beginnings 
of records of cases be made for the academic benefit to be reaped 
later. This procedure will often arouse your enthusiasm for study 
and scientific application, and you will highly value these early 
attempts to understand. 

The use of the X-ray in diagnosis has become quite general among 
the men who are making the treatment of this disease their special 
work. Radiographs will often confirm a diagnostic opinion, and 
records of cases are far more valuable when supplemented with them. 
They show positively the bone diestruction in the alveolus and offer 
further proof as to suspected necrotic or septic areas. The radio- 
graph plainly shows us when not to attempt the impossible in treat- 
ment, and, conversely, is a strong argument when we are obliged to 



OK AL HKAI. I H |^ 

condemn for extraction certain teeth that the patient %nthc» to M%r 
I'.xperience and familiarity with ty|>es of casts are ntcemmry to 

develr)|) ability in diagncj^i^ 

C)ral jirophylaxsis is ihr next *tr|> in our Ir- ••' \ and ff^f m 

both preventative and curative. lo do efficient . tlong ihs ksr 

is so essential and yet so simple, so gratifying in rctialu both to 
patient and dentist, that to neglect it is incom{»rrhenttble. 

i.vcry mouth prrscntrd for any dental scrvKe whalcver should be 
prepared for the operation by having standard prophylactic treat- 
mriit. and this rule is particularly |>ertinmt in the Irralmcnt ci 
pyorrhea, for no good surgery may be accomplished in an uncWma 
mouth. Asejisis makes all surgery i>os»ible. 

I he conditions tliat make for immunity agaimt pyorrtiea piacr 
th(* burdtMi largely u|K)n the patient Success deftends. not alone 
upon the skilful surgical technique of the of>erator. but also upon his 
ability to so imbue the patient with enthusiasm and |iroducr drsvr 
for oral cloanlincss that he becomes keen on the idea He 
(iistinctly underst.ind that if his month is to l>e cured ol 
and disease-generating condition, he himself must work 
lo that end. 

Whatsoever of personal success I ha\e attained in this work. I 
atlributr largely to the fact of so shaking up the cr>f ' 

patients to the importance of this phase of treatment ih.i: 
sooner miss a meal than neglect a mouth toilet 

This recjuires mmule and careful instructions Ilie loolh br\t«h 
should be «mall and of good quality, and each individual ihoold 
possess three, so that a dry one is always available Ilie brush m 
u«ed in such a manner that no surface of the teeth, either lingually oi 
buccolabially is neglected I he gingival bordrr i% the |>o«il ol 
infection in all cases, and it is here that the patient's altenlioo shouhl 
l)e directed The stroke should describe a small circle no longer Hi 
diameter than the bristles of a brush I ell patient* to brush «U the 
Hirfaces of all the teeth .Show them how to do it in pAlHoauiie «l 
their first visit, then watch and correct defKiencies in thnt le«:KnM|u<- 
and encourage them in their work. Regular and * 1 oral 

hygiene in every case which undergoes treatment ts in the luiai aAMy* 
M< the summtim hnmun of immunity 

Almost every case of pyorrhea presents teeth thai .ire ln»e M? 
observations have led me to believe that a large |*r ' m*e 

loose teeth are in a state of traumalK occlusioo. ^xmie ha^ •© 
antagonist in the opposing jaw. it is true, hut il ma\ f»e fauild thai 
the cKcluding l«>oth has been lost since the hwM'nesa de%elofiea 

Trauma of the bite is the nu»t aggravAiiML.- ^vmnton ol the eolvr 
problem and. in my piactice. it is the t -m that tt€r%t^% 

attention lo illustrate An up|>eT bi cusj^d |»fesmls for lieaimef* 
because of soreness, and the examination reveaU that, when the |a^«^ 



170 ORAL HEALTH 

are closed and the teeth in contact, this individual bi-cuspid is thrust 
in the line of least resistance. It receives a distinct shock each time 
the jaws are closed, vv^hich drives it into its socket, the tooth immedi- 
ately resuming its former position when the pressure is released. Such 
a case can only be relieved by grinding. Now, when such a condi- 
tion presents in a mouth, it is usually accompanied by a similar con- 
dition, although in less degree, in some, or all of the remaining teeth. 
A lateral stress on the teeth, when in closed position, will usually 
disclose movement if the tip of the index finger is rested gently on the 
suspected crown, just at the gum margin. I cannot be too forceful 
in the following statement: No prophylaxsis, no root surgery, no 
medication and no splints will improve the condition until the trauma 
has been entirely removed by grinding. We must grind the occusal 
surfaces of these teeth even if they are sensitive, even if there is no 
enamel left, and even if they are reduced to stubs. It may be neces- 
sary to remove the pulps and to fill the root canals, but in any case 
there will be no improvement from treatment if this shock to the peri- 
dental tissue is not relieved. This work is dental surgery as a last 
resort. It is grind and relieve trauma or lose the teeth. 

Now I am not advocating that you use a large wheel carborundum 
stone and deliberately shorten the tooth until it is no longer dislodged 
by occluding. This may be done if one is desirous only to save the 
tooth or where, in the case of a molar, the tooth is destined to carry 
a crown or act as an end abutment in bridge work; but in most cases 
where the osteoclasis is not extreme, one desires only to relieve the 
aggravating symptoms, and ruthless or extreme grinding would so 
mutilate the occlusal surface, that the tooth could never functionate 
again unless an artificial occlusal surface restoration were made. 
Entire and complete rest in all these cases is the desired object. Use 
carbon articulating paper to define the exact ultra-occluding contact 
point, and a variety of small carborundum stones in the engine hand- 
piece, and grind only such surfaces as are marked by the carbon 
paper, sometimes on the lower javv^, sometimes on the upper. Urge 
the patient to a free use of the lateral movement of the mandible m 
marking the teeth. 

The natural wear on the occlusal surfaces of the teeth ceases when 
trauma is established, and the object of the operator is to so grind 
the teeth that the same effect and appearance as in natural attrition 
is attained. Try to preserve the natural tooth form and give all the 
time that is necessary to the operation. I have recently spent nine 
hours on one case in grinding the bite for the relief of this condition 
before the result was satisfactory. Those who have made a study of 
the Gysi method of anatomical occlusion in articulating artificial 
teeth will understand the significance of this. Those who have not 
rvill understand when they have accomplished one successful result. 
Correction of trauma by grinding is to me a fundamental necessity in 
the treatment of pyorrhea. 



ORAL HLAL I fi I7I 

Wc now come to ihe actual surgery of pyorrhea mnd »*" "-^-rtioa 
of suitable instruments. Ilicse are of nuBirr(Xi« dr^i^ru %eu 

bearing the names of the designers, nearly all of which produce 
e(jually good rr^ults when in skilful hands. 

Dr. A. C. Ham. uf Denver, stales: "It is the %urgc(m and nol die 
instruments that performs successful o|>erations. though mftnimeiiU ol 
proper design arc essential." Ilie instruments used are ol ihrer du 
linct types, the planes, the curettes, and the files (irxxJ rtamples ul 
the plane lypr are the Carr set. which is com|>osed of I SO m«lrufiienl«. 
the Harl/rll and the Buckley .sets, the two latter bemg modiScalion* 
of the former and more suitable for the begmner. I"he plane h 
operated by a pull .stroke from the |)omt toward the handle, the \ 
bit. or knife, being ^et at the poirjt. and so set that '. ' ' '- I. i . 

rests upon the surface of the root, a |>ortion of the sha;.«. , »? '\^ 

same time, rest u|K)n the crown enamel. This gives the oj-rrat jf 
control and delicacy that a hoe instrument does not Planes aie 
ef^pecially valuable for good results in deep |>ockrls. Ilie curette is 
designed as a "p"'^^^ **"d f)uir* instrument I here are numr' 
designs of various manufacture. Ilie (icxKl ^ ounger set (< 
Dent) is recommended for beginners. Ihe Hutchmson moci ; 

of the Good- Younger instruments (made by Grafrath. NA.) are 
delicately fornK'd and braulifiiliy (unshed. Certain selection* frooi 
this set are indispensable. I he liles. with a few cxc^t,u.,r^^ xt .J>«^ 
ietc in modern techni(jue. but Hutchinson's set (n. . ; 
N.Y.) are not designed as scalers in the true sense, and are %ali; 
when used correctly. 

In th<' deeper ptKkets on pyorrhetic teeth, thet'- - ■► •'—' ? -"' '-'•eted 
material in the cemenlum of the r<H)t surf.iir li t<0cd 

as calculus. It is a membraneous-like substance that ts easily removed 
by successive short strokes until a surface not unlike thai ol an ; 
billiard-ball has been discloM-d After th- cal suffaces h^i*'' 

been made clean, and. not until then, slu ....: ihe inslfumrnt* H- 
directed into the pmkets. Hie advance is made by short 
direction of the apex I ach field is first made clean l>efofe adva> 
to the next. «<) that, when the depth of the |Hx-kef ' ■ ' 
all objectionable matter has been removed from Ut» f««. ;«. 
root. 

When the necrotic membrane has l)een removed, instiuni 
should cease. Deeper and below lie the n 
can.iliruli and. tjnce the hard outside layer "t 
laled by an accidental scratch or groove, th 
receiving aid from those wonderful natural forces that r 
struction and repair. Hart/ell has |H>inted out how these 
the cause of reinfection to the deeper Livers ol the rr- > 

how unresponsive such teeth are to tr^ • •» 

I should like to say a vsord here .i »e Uie ol, ^ -v.-fvl .v • 

septics and germicides that have been advocated. I ne uw of Iww 



172 ORAL HEALTH 

agents is contra-indicated. Because of the well nigh impregnable 
position of this infection, the natural forces of defence against it are 
unsuccessful and the phagocytosis difficult. Then, too, the inaccessi- 
bility of the infected field is the great obstacle to the surgeon. Were 
these infected surfaces entirely exposed to our view, the question of 
surgery would not be pertinent to our subject. Together with 
mechanically reducing the necrotic surfaces, we must depend to a 
large degree on the aid of nature's own defence. The normal de- 
fence must be conserved, and any application of astringents or 
escharotic germicides in solution or otherwise, introduced into these 
pockets, is an irritative attack upon the normal defence. 

The operation of clearing the root surface of all necrotic debris, 
usually starts a profuse hemorrhage, caused by the opening up of the 
small gingival arteries in the adjacent vascular tissue. This hemor- 
rhage of fresh arterial blood brings to our aid the leucocytes and 
phagocytes, the army of defence, which is capable of doing more 
real harm to the invading bacteria than any known germicide. Par- 
ticles of debris, whose removal by other means would present a diffi- 
cult problem, are here flushed out, carrying along the remaining 
hoards of bacteria. After the instrumentation has completely un- 
loosened the necrotic tissue and the hemorrhage has flushed it out, a 
clot forms in the space, sealing the wound for the osteoblasts to set up 
the process of repair, which begins immediately, and brings the 
charmed circle of cure about. 

The prophylaxsis and treatment of pyorrhea is no light responsi- 
bility upon us. The day will come when to have the average case of 
pyorrhea develop in slow ways under a dentist's supervision will take 
on the aspect of mal-practice. If dexterity in technique and experi- 
ence in handling a marked case is not in hand, much can be done in 
prevention, although the first can be learned as well. Here, then, is 
real knowledge of the kind a man can use. It is the "pj'^ctical 
power" to which Froude refers, and I feel that I serve you best by 
giving you the sort you can benefit by. 

Your kind invitation to address you has given me the opportunity 
to make an appeal for greater knowledge on this subject, and my 
motive in coming before you is missionary. If I can leave behind me 
a desire in the hearts of some men to incorporate in their practice this 
most important branch of our work, to help in the stamping out of 
this health-destroying disease, I shall feel that my coming has not 
been in vain. 



Erratum 



In article on "Successful Practice of Dentistry," March issue, page 
8: Read 5% instead of 6%. 



Silicate Restoration of Peg-shaprcJ Lateral lnci*oi* 
W. EL Wmiit. Abincoon. Va. 



T\U\ first 5tr|) is to repair the tooth as though you were to pitf 
a gold crown on it. Iliis often rrquires very little prepaiatioa 
except to cut some small grooves m the enamel m order to five 
cement atlachrnenl. 

Second, make a gold sfiell crown for the tooth, using any mdliod 
you may choose Be sure that the crown is prof>er uie to cof f C HJO ad 
with the oth(*r teeth and make it fit snug at the gum margin A1m> 

have It well reinforced at th<- incisal -I • • '^ .. .il.t ...l .i._ .. .L^ 

may be brought to bear on it in ma , , in 

the mouth and with a small sharp excavator or mstrumeni make a 
mark around the visible part of the crown; mark across the front aI 
the gum inargiii and in each approximal space as far as the croum 
IS plainly visible from direct front view. Remove and cut the entire 
front out to the outline marked, fie careful to prrsrr\e the l>and at 
the gum margin and the thickness of gold at the inctsal edge llm 
can be easily done with a small emery-stone. Krplace the Cfo%m 
and see that you have not distorted it in any way. also that you ha%r 
cut It sufficient to get nd of the appearance of gold at the front. 

Iliis done, you now cement the crown on the tooth as though you 
would a gold crown by filling with soft cement and holding your 
thumb over the front while you are forcing it in place and the 
cement is setting Before the cement thoroughly sets you may remoire 
any excess from the front, as lhi> will sa\r you the tr«Hjblr of culling 
it after it is hard. 

Dismiss your patient and give the cement plenly of lime to gri 
hard and have them to return at another engagement. apf>ly the 
rubber dam. remove enough of the cement around the margin of 
the gold to .illow sufficient undercut for a filling And ali you Ka%e 
to do to have a piece of work like the s|>ecimen 1 present you here 
for your inspection is to put in a syntfietic ; nn fillmK m the 

entire front of your crown, lieing careful in H-inJnig youf Miadr to 
match the other teeth and following the proper proceckve in the 
nanipulation of your materials, which are familiar to all of you wfio 
.Te using synthetic. Ilus has ad\ antages o\rTChe allsKell fiorrelaai 
crown, or most any other form of crown ytxi might th«*iwe to make. 
in that you have not weakened the UhaU, yoti ha^'- • -^ » .»..'twr.l iKe 
life of the pulp, you certainly can ci>me nearer <t 

teeth in color than with any other fmm of crov»n. and »l the potre 
lam front should give way it is easily replaced 

In my judgment, this is a \ery salt * %} . hath U. |^.p^».. 

and yourself, to restore a |>eg-»ha|>cd U: ^Jf. 

•ninir nwvn h*-torv i\m\rnt\on ol Ihr v,.^.... Mt.i* lw«il*t 
ntnni). Vn . Novrinh«'r. I>I8. 




l\iiiil)linu>ntar.v oopios ot 
OitAi, 111. A i.rii will l)i> son I 
(luriiiu tlu> pniyrross of the 
u;ir \o all IK-iUal (iraduatos 
on aclivo sorvioo wlu)so 
army aildri'ss is known. 



i HONOR ROI.I. 

^ Mijor C. E. Sale. 18th Batt., 4th Brigade. 



CANADIAN ARMY DENTAL CORPS 











O 


verseas^' 








Lt.-t^ 


>1. . 


1. A. Anns! long". 


Capt. 


.\. 


W. Wiunolt. 


Lieut. 


C. 


E. McLaui^hlin. 


Majoi 


C. 


K. Gib.>^<m. 


Capt. 


(.\ 


l-\ Walt. 


Lieut. 


R. 


McMeekin. 


.Maioi 


A. 


A. Smith. 


Capt. 


J. 


E. AVright. 


Lieut. 


R. 


V. .AleNally. 


Capt. 


J. 


W. Poll. 


Lieut. 


H. 


F. .\ltord. 


Lieut. 


E. 


INIcNeill. 


Capt. 


t^. 


Hrown. 


l^ieut. 


(.^ 


Atkinson. 


Lieut. 


Jl. 


C. Alacdonald. 


(\ipt. 


J. 


F. HI air. 


Liieut. 


U. 


H. At key. 


Lieut. 


J. 


AV. Maedonald. 


Capt. 


Ct. 


N. Hri.i;,i;s. 


Lieut. 


AY 


. A. Burns. 


Lieut. 


E. 


D. Madden. 


Capt. 


\v 


J. Hontloy. 


Lieut. 


G. 


H. Hray. 


Lieut. 


Y. 


C. AA^. IMarshall 


Capt. 


c. 


S. Cameron. 


Lieut. 


H. 


Clarke. 


Lieut. 


L. 


L. Matchett. 


Capt. 


o. 


A. Elliott. 


I^ieut. 


A. 


R. Currio. 


Lieut. 


G. 


A'. Morton. 


Capt. 


E. 


A. Grant. 


Lieut. 


G. 


11. ]<\>\vler 


Lieut. 


J. 


F. Morrison. 


Capt. 


AV 


K. l^.roeno. 


Lieut. 


A. 


A. Gar fat. 


Lieut. 


J. 


B. INIorison. 


Capt. 


Cooruo Cow. 


Lieut. 


AY 


. H. Gilroy. 


Lieut. 


C. 


H. Moore. 


Capt. 


O. 


G. llassard. 


Lieut. 


IX 


H. Hanuuell. 


Lieut. 


P. 


E. Picotte. 


Capt. 


J. 


E. Holmes. 


Lieut. 


J. 


AA'. Ha.uey. 


Lieut. 


H. 


Ross. 


Capt. 


G. 


G. Hume. 


Ivieut. 


H. 


C. Hod.uson. 


I..ieut. 


J. 


Roy. 


Capt. 


F. 


W. B. Kelly. 


Lieut. 


E. 


AY. Honsinger. 


Lieut. 


AA^ 


. A. Sangster. 


Capt. 


U. 


liionai.>«. 


Lieut. 


E. 


C. Hutehison. 


Lieut. 


J. 


F. Shute. 


Capt. 


F. 


R. Mallory. 


Lieut. 


R. 


Jamieson. 


Lieut. 


D. 


P. Stratton. 


Capt. 


A. 


E. Rlullin. 


Lieut. 


J. 


Ij. Kappele. 


Lieut. 


R. 


C. H. Staples. 


Capt. 


R. 


I.. Neiley. 


Lieut. 


E. 


J. Kelly. 


Lieut. 


E. 


S. Tait. 


Capt. 


K. 


Iv Sparke.-*. 


Lieut. 


O. 


Leslie. 


Lieut. 


L. 


A. Thornton. 


Capt. 


G. 


IT. A. Stevenson. 


I^ieut. 


A. 


G. Loujrh. 


Lieut. 


H. 


P. Thompson. 


Capt. 


T..- 


N. Trudeau. 


Lieut. 


C. 


A. IMeRride. 


Lieut. 


H. 


P. Travers. 








Lieut. 


AA' 


. G. MaoNevin. 


Lieut. 


D. 


D. AYilson. 


t^ra.ior W. Iv Clayttm. 








Lieut. 


Karl F. AA'oodbury 








Cone 


enl 


tration Camps 








Capt. 


G. 


C. Honnxeastle. 


Lieut. 


IX 


.1. Bagshaw. 


Lieut. 


J. 


II. Duff. 


Capt. 


F. 


11. Kradlev. 


Lieut. 


J. 


A. Reatty. 


Lieut. 


J. 


N. Dunnins. 


Capt. 


C. 


D. DesTirisay. 


Lieut. 


V. 


C. BH.Ui;.'5. 


Lieut. 


AY 


. R. Ea.man. 


Capt. 


D. 


M. Foster. 


Lieut. 


T. 


AA'. Caldwell. 


I..ieut. 


R. 


AA'. Fell. 


Capt. 


AV 


. Y. Tlavden. 


Lieut. 


C. 


E. Cann>bell. 


Lieut. 


H. 


B. Findley. 


Capt. 


Ja 


^. M. Ma.uee. 


Lieut. 


:E. 


H. Can\pbell. 


I^ieut. 


R. 


AA'. Frank. 


Capt. 


IT. 


Ti. Ariteiiener. 


Lieut. 


.\. 


A'. Cash man. 


I>,ieut. 


J. 


P. Gallai;her. 


Capt. 


s 


IT. SinH>son. 


Lieut. 


E. 


H. Crawford. 


Lieut. 


G. 


E. Gilfillan. 


T.iout 


. J 


T. Adams. 


Lieut. 


Karl Damon. 


Lieut. 


J. 


S. Girvin. 


IJont 


. s 


G. Alderson. 


Lieut. 


J. 


^I. Deans. 


I^ieut. 


AA' 


. T. Hackett. 


Lieut 


. N 


. S. Bailev. 


I^ieut. 


R. 


L. Dudley. 


Lieut 


H. 


J. Henderson. 



tActini;- Direetor of Dental Serviees, address Ottawa. ^Lieutenants rank as 
Captains while overseas. C.A.D.C. overseas address — Care Direetor Dental 
Serviees. Canadian Contini;ents, 2S Earls Ave.. Folkestone. England. 




•■A 

r ^ 



SgUL 






t\ 



:i\ 



\^ *• 



\:l> 



k»i 



AXIA 



W^l 



'y>v:-y^Ti^^v& 



Concentration Camp«. — rContinued.) 

U«ut. IV J li«>al.-> Ueut. W. H. 

L.l«Ut. r. H:ri.!- IJ.I1* T- I» \' 

L.J«^t. It L 

Ueut. Git id. I. 

Ueut. H- C. U«?ui H. 

Ueut. C. M. Urut J. • 

Lieut. Vr ' r- L.i«-ut K At 

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MULTUM IN PARVO 

This Department is Edited by 
C. A. KENNEDY, D.D.S., 2 College Street, Toronto 

HELPFUL PRACTICAL SUGGESTIONS FOR PUBLICATION, SENT IN BY MEM- 
BERS OF THE PROFESSION. WILL BE APPRECIATED BY THIS DEPARTMENT 



D 



D 



n 



Fastening Stones to Wornout Mandrels. — Wornout 
mandrels may be made to hold a stone well by placing a little soft 
cement on the screw and running to place in the engine. — Australian 
Journal of Dentistry. 

To Keep Modeling Compound From Sticking to the 
Fingers. — -Modeling compound, particularly if softened with dry 
heat, is likely to stick to the fingers. This can be prevented by rub- 
bing a little coca butter on the fingers. — H. Reid Staley (Dental 
fievierv). 

Removing Plaster From Vulcanite Plates. — The dental 
laboratory worker sometimes finds, on removing a plate from the 
flask after vulcanization, that the mold or model plaster has formed 
a hard and strongly adherent layer of crystals on the surface of the 
vulcanite. Prevention is, of course, better than cure, and one ought 
not to be so careless as to leave the flask in water for some hours 
after vulcanization. In cases where one can afford to wait for the 
gradual action of a slow solvent, the following method will be found 
very satisfactory: The well-washed plate should be immersed in a 
strong or saturated solution of sodium throsufate — photographers' 
"hypo" — and left in this solution overnight. On removal from the 
solution, it will be found that, in many instances, the incrustation has 
been entirely dissolved. Should some crystals remain on the plate, 
they no longer adhere closely, and they can be readily brushed away, 
leaving the vulcanite surface quite clean.- — Dental Record. 

Babbitt Metal. — The reason why Babbitt metal is preferable 
for dies is that it has all of the five requisites for a die, viz., non- 
shrinkage, hard enough not to batter, tough enough not to break, 
makes a smooth die, melts at a low temperature. It may be added 
that a plate swaged on this metal fits the plaster model. — L. P. 
Haskell, in Dental RevieTO}. 

To Remove Tin-Foil From Plates. — After burnishing foil 
over model, if you will soap it you will find that the foil will not 
adhere to plate. I very seldom use foil, but in soaping model after 
separation and letting it dry well I find it answers the same purpose 
as the foil. — Literary Digest. 



ORAL UKALTH 177 

PrF.VF.NTINC THF: Ckac KINC. AND 1' Kf r s 

— When a patirnl prwcnts wilh chapj : .., . ^ 

and bleed if stretched, the li|>s arc coated with tr^. ne 

lips will then be soft and pliable, and will sirHch without crackmf or 
bleeding. S. M. Mvcrs ( I cxas Dental Journal). 

Skitinc IUndfI) (kouns Painlf>si.y In ihow catrs ythat 
the gums are particularly sensitive the cementing of a bandrd crown 
is sometimes quite painful. If a small pellet of cotton about the ti/r 
of the head of a pin is dip|)ed in 95' of phenol and (MUMd %nlh the 
|)liers around the root just under the free margm of the gum a frw 
limes it will be found that the sensitiveness is greatly dtmifmlmi 
Have at hand some absolute alcohol, so that m faw ihr t.htf'ftol 
should flow on the tissues beyond the root the caut ol 

the phenol can be instantly checked with the alcohol A ti f /im- 
Uil RcvicnO- 

I'lniNc; rm roxcuF. Bfhinu im .-<)» i Pai • -nr 

weeks ago a patient came to see me complaining of a nu., . , 
discharge from his nose, which he said he thought was due lo 
polypis. I examined his nose and throat, and could find nothing more 
than a post-nasal catarrh: however, he was not satisfied, and said 
he was certain that he liad polypi, because he could ferl lh«m. On 
my asking how he could do so. he at once put his longur rif^ up 
behind his soft palate into the naso-pharynx; he said hr could thm 
feel a ridge in the middh* and a soft mass on each side (no doubt the 
posterior ends of the turbinates), winch he thought \s' ' We 

appearance on looking into his mouth during the r*' v .<..»» moiC 

peculiar; the soft palate was bulged forvsards. an<: ic iHobrd 

up so far behind it that the uvula was in contact with the framuHl 
linguae I showed the case to four of my colleagues here, and as 
none of lh<-m had ever seen or heard of anyone who could peffofw 
this feat. I thought it might be <'f interest to int on rn'ofd f O 
Stcdnuui, M.n., Londoti ( liritish Mcilinil / 

I HK I'OOTHBKI SH lUlin When did the I Jiglish twsl 
the toothbrush habit, wh'ch is now being denouncetl 
cal .iuthorilu*>^ In "l-.smond." lharkria\ t- -^ • ' 
spend ".I tenth of his day in brushing hi* ter- 
hair." and in doing so the novelist commit* 'le an.i 

During the first half of the eighteenth century all hne gr 
wigs and had no use for oil on their hair. \*hil«f •' - . x 

so late as I7*)4 unknown to Lord CheMeiheld x\ .,; ? '.> • 
Cheslrrlield *avs: "I hope you lake great care ol ymir mnwiK and 
teeth, and that you clean them well every morning v. 
and tepid water, vsith a few drofM of arxu " ^txofuwa 

into it ! insist upon vour ne\er u* f»Afd «■*- 

stance whale\er. which always rul •'nTmr tm 

varnish of the teeth " London Chronicle (l^mUil ^ 



Military Efficiency Depends Largely Upon the Teeth 

FROM lessons learned through experiences in the struggle at 
present progressing in Europe it would seem that the old saying, 
"An army travels upon its stomach," would have to be replaced 
by "The efficiency of an army depends upon the condition of the 
teeth of the individual soldiers." When the Kaiser lighted the torch 
which set Europe ablaze, the full importance of good teeth was, 
perhaps, not fully appreciated by the heads of the British War 
Office, and many of the territorials and reservists who were first 
called to the colors and volunteers who presented themselves for 
service were seriously handicapped by bad teeth. In some instances 
they had to be returned from the trenches in order that their teeth 
might be put in condition to enable them to eat hard biscuit and other 
rations served out to the army. It was found that if their teeth were 
not perfect they not only were unable to eat the food supplied them, 
but in some instances were rendered unfit for action through pain 
from defective teeth. Discovering this, the War Department took 
immediate steps to see that the men who presented themselves for 
enlistment had a perfect set of teeth or they were supplied with them 
before being sent to the front through the dental service for soldiers, 
which is now a perfectly organized department of dentistry in con- 
nection with the military hospitals, and in fact of the entire medical 
branch of the army, both in Great Britain and her colonies, as well 
as at the front. 

Dentistry is playing a prominent part in caring for the wounded 
in the hospitals at the front, and is in many cases quite as important 
as surgery. The dentist is particularly valuable in event of serious 
wounds of the jaw and face, with which ordinary surgery is not well 
able to cope. Many a wounded man will return at the end of the 
war who would not have been in shape to show himself to his fellow- 
men were it not for the skilful work of the army dentist, assisted by 
modern plastic surgery. As a consequence of the war being waged 
largely in the trenches, many of the injuries are to the head, and 
frequently it is the jaw that is affected. This is due largely to the 
fact that the head only is exposed in this mode of fighting. A soldier 
shot in the head, with a penetration of the brain, usually dies, but if 
the face area alone is penetrated he usually lives, the probable extent 
of the injury being a fracture of the bones of the upper or under jaw. 
It often happens that the most distressing pain which a soldier en- 
dures after receiving a severe wound in the face is due to exposed 
nerves, and the dentist can most readily give him relief through treat- 
ing it. — The World Window. 



i ORAL nF.AI.TII B, 



I 



EDITOR 
WALLACE SECCOMBC. DOS.. Toronto. Oni. 

CONTRIBUTING EDITORS 
GEORGE K THOMSON r ' 
F. W. BARBOUR. DO S 

ASHLEY W. LINDSAY. O O •> '• „ Qn^^n 

J. WRIGHT BEACH, D.O.S.. BufT > 
T. W. WIDDOWSON. L.O.8.. London. Ln^lAnd. 
J. E. BLACK. O.O.S.. Vancouver. B.C. 
MANLY BOWLES. D.D.S.. Winnipeg. Mjn 
J. A. C. HOGGAN. D.D.S., Richmond Vj 
EDGAR D. COOLIDGE. D.D.S.. Ch i. 

RICHARD G. McLaughlin, d.d.s to. 



Knl**ro<l I 
scrlptlon I'rlcc 

Orlicin&l CommunloAtlnnii. Hanh |i«v|*w«. V.\ 

r onnl IlwfnM ntul »>" 
•or. Orn! H.nlth. :'• 



to 



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lOiould b« 



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What Is L npiofessional Conduct? 



A I the ircriit mcrliiiK of thr Koyal .MciIkaI CommtlMan. 
.ippomlcd by Order in Council of ihr ('..<% rftinirii ol t\y 
Province of Ontario, the |>ower of the M uncil lo 

di5cipline the member* of the medical profrwion ramr up lof tcrioufi 
di5cu!(5ion. and incidenl.illv »ome criticism frinn one <ic mntr jMit»- 
fied in<rnb<Ts I hi5 \\ but one of tlie |»eruHiic«l u;'-'^ *'• '* *• ^^'"^ 
m.irki'd the promrs^ of professional Mrtudartl*. i 

maintained largely tbrougb the diMriplmary powrtt \ lo ihr 

Kovermn^^ botjie* of the several profe*>u>n* 

It miKht not be amiM, at »uch a iH-ruxJ. lot lUc tknlAi ja t^-ttj «i 

to examine its legal arm«>r for |K>**ible \u' ^ - '■ 

of the younger prtjfevMons we ha\e l>ren 

the Legislature of Ontario, at leaM. and a» n rr»ull Bt*. c 

tivrly speaking, in a fairly sound iH>uln>n in our «" «^ 

members of the prtjfession and the HB%r 

one unsalisfarlorv <pnl, i oninion t 

in.Utrr of (Ir.iling \\\i\^ ..if.ut; » 



180 ORAL HEALTH 

Not that the power granted by the Legislature to discipline the 
members is too meagre or too weak, but that the college has failed 
to take full advantage of its power and place in plain language in 
its by-laws the proper interpretation of unprofessional conduct. As 
it stands at present, such interpretation is left largely in the hands 
of the presiding judge. 

The words "unprofessional conduct" may mean much or may 
mean little according to the dental education and personal opinion 
of the court. The question of what class of conduct by a profes- 
sional man comes under the head of "unprofessional conduct" should 
not be left to be interpreted by the different courts, but should be so 
specified as to leave no loop hole for escape. 

Some of the dentistry acts through the by-laws, passed under 
statutory authority, boldly and definitely state the grounds upon 
which a license may be suspended or revoked. The Province of 
Quebec has decidedly the lead in Canada in at least this one par- 
ticular, and have been wise enough to set out in detail the individual 
misdemeanor and misconducts that are declared to be "derogatory 
to the honor and dignity of the dental profession, and therefore 
breaches of discipline." Quebec has seen fit to imitate an ancient 
and venerable law, and has arranged this particular by-law in the 
form of Ten Commandments; and whilst she may, by being so 
specific, have omitted a few items, yet we feel sure if these ten 
commandments specified in her by-law are properly enforced, the 
members of the profession in Quebec will be walking the "straight 
and narrow way." 

But the important point is, that the interpretation of "unprofes- 
sional conduct" is not a matter that should be undertaken by any 
one province apart from the other provinces. Surely this is a matter 
that the whole profession in Canada should be able to agree upon. 
What is "unprofessional conduct" for a dentist in Ontario or Quebec 
is just as surely unprofessional conduct for a dentist in British Colum- 
bia or Nova Scotia. Then why not have an interpretation of this 
troublesome and vague phrase, that will be a standard for the regu- 
lation of the profession from the Atlantic to the Pacific? The courts 
would certainly welcome such a simplification of obscure clauses, and 
an added strength would thus be given to the governing bodies of 
dentistry in the different provinces in any prosecutions that might 
occur. 

The Dominion Dental Council might render valuable service in 
such a matter. The council has already done splendid work in 
unifying the Canadian dental profession and in raising its educa- 
tional and academic standards. Here is an opportunity for another 
forward move. 













Dental Disease and Diet. 

^ Exclusive of Dental Caries, Digestive Dis- 
eases have increased 103 per cent, within the 
past thirty years. It would be illuminating to 
know what the percentage increase would have 
been had dental disease been included. 

^lAll digestive diseases, including dental 
lesions, are to be ultimately controlled through 
sane and scientific diet. 

^ People are nowadays said to "dig their 
graves with their teeth.'* The sooner people 
are educated to "eat their way back to health" 
the better. 
















Frederick Lester Stanton, D. D. S. 
New York City 



^ 



m 



OPAL H E ALT/\ 

A JOURNAL THAT STANDS FOR THE •'OLNCE OF 
PREVENTION," AS WELL AS THE "POUND OF CIRE" 



lis 



n 



VOL. 6 



TORONTO. MAY. 1916 



><.. 



Dental Surveying and Arch Predetermination — New^ 
Evidence in Favor of Early Treatment 



Frederick Lester Stanton, New York Cm 



IN preparing an article for Oral Health, the author would refer 
the readers to the following data for a better understanding of 
the material that will appear in this paper. 

At the International Congress at San Francisco, a i)aper was pre- 
sented describing an instrument for surveying the dental apparatus by 
means of orthographic projections. 




Ax 

A/ \C 



b^ 





3 



(a) PERSPeCTWE 



(b) ORTHOGRAPHIC 
PROjElCTlori. 



Fig. 



Fig. 1 shows Orthographic Projections and IVrspectiMv In (b) 
the points A, B, C are projected in straight parallel hnos to tht- 
drawing plane and appear at (a), (b) and (c). While in per- 
spective, the points A, B and C appear on tho drawing plane at 



184 ORAL HEALTH 

(a), (b) and (c), the eye of the observer being at '*S," in the ortho- 
graphic projections the eye of the observer is at infinite distance in 
the direction of the parallel projected lines. 

In the May issue of the International Journal of Orthodontia will 
appear an article with the description of a complicated case, showing 
maps of malocclusion and a predetermined arch into which these 
teeth should be moved. In the original paper the possibility of deter- 
mining the arch was viewed from the mathematical viewpoint, but 
since the publication of that paper, Mr. Gilbert Dudley Fish has 
invented an instrument (The Occlusograph) which will determine 
mechanically the arch of any given case. This instrument will be 
shown at the New York State Society at Albany on May 11,12 and 
13, 1916, and will presumably be described in the Dental Cosmos. 
In order that this paper may be of interest and benefit to the profes- 
sion, it is proposed that some of the benefits of this method be outlined 
in relation to specific type of cases: malocclusions of deciduous and 
mixed dentures — cases between the age of five and eight. The fol- 
lowing technique has been followed in reaching these deductions: 

The models have first been surveyed and the position of the teeth 
mapped, the final map showing the relations of the upper and lower 
teeth. By means of the occlusograph the arch for each case has been 
determined and a map made of the occlusion. By sliding the map of 
occlusion over the map of malocclusion, a position has been selected 
that requires the least tooth movement to move the teeth from mal- 
occlusion to occlusion. 

In surveying a number of cases of malocclusion, the author was 
forcibly struck by the following facts: namely, that the arch was 
generally too narrow; that the lower incisors keep very nearly their 
normal positions; that the upper incisors were generally flaring out- 
wardly, their incisal edges being too far forward. 

In taking very young cases, that is, previous to the eruption of any 
permanent teeth, it was found that the greatest fault appeared to be 
in the narrowness of the arch in the region of the temporary molars, 
especially of the second temporary molar. In observing a case at a 
little later period at the time of the eruption of the first permanent 
molars, these teeth seemed to take more nearly their correct positions 
at the time of their eruption, but in order to make contact with the 
end of the deciduous arch, which we have noted is too narrow, the 
mesial ends of the first permanent molars rotate lingually to make 
contact with the narrow temporary arch (Fig. 5a and 5b). 

While the first permanent molars often require expansion to put 
them in their proper positions, still we can say that the arch is, as a 
rule, more nearly normal at the first molar than in the region of the 
second temporary molar. In examining a series of cases at the 12th 
year, it was found that no matter how much the arrest of develop- 
ment was in the anterior part of the arch (even where there was 
extreme narrowness in the first molar and bicuspid region) the second 



ORAL HEALTH 185 

permanent molar was able, in most cases, to assume a correct posi- 
tion in the width of the arch; in other words, the vast bulk of mal- 
occlusions consists of too narrow arches in the deciduous set. As the 
palate grows to accommodate the first, second and third permanent 
molars, it becomes more normal in width in the region of the first 
permanent molars and generally correct in the region of the second 
and third molars. While we have found exceptions, these facts are 
presented to focus attention to the point that malocclusion of the 
teeth is a deformity primarily of the temporary molars and later of 
the permanent bicuspids. 

Inasmuch as the medio-distal diameters of the four temporary 
incisors are about on the average seven millimeters less than the per- 
manent incisors, it follows that if the lateral halves of the temporary 
arch are too narrow and there are no spaces developed between the 
temporary incisors, the permanent incisors cannot take their proper 
positions at the time of their eruption. The lower incisors, especially 
the centrals, assume in most cases a very close proximity to their 
correct positions, and the laterals, not having sufficient spaces, are 
usually situated lingually to their normal positions. 

In the eruption of the upper incisors, we have, as a rule, a flaring 
outward of the incisal edges, and a crowding and consequent rota- 
tion of these teeth. As a result of surveying and predetermining 
arches, this picture has become so firmly implanted in the author's 
mind that it would seem that all malocclusions form more or less a 
common picture, and that the logical procedure would be in treating 
these cases and restoring them to their normal arch-form and occlu- 
sion, to first place the side teeth — molars and bicuspids — on their 
correct width and curvature, and then attend to the anterior part of 
the arch. In the papers on this subject, we have pointed out that the 
form of any dental arch is dependent on the tooth material, or bettor, 
the inter-relation of the sizes and forms of the teeth of that individual. 
In other words, in occlusion we have definite bodies, the teeth, and 
it is known that certain points on these teeth must fit with definite 
points of the teeth of the opposite jaw, and that the tooth have a 
definite arrangement among themselves; that is, individual tooth have 
contacts that must make contact with their neighbors so that this 
definite mechanical relation that each tooth bears to the other teeth 
and to the whole arch, accurately determines the position those teeth 
must occupy to be in normal occlusion. I o bettor illustrate this, the 
following drawing (Fig. 2) is made of an individual having upper 
incisors — centrals, 9.0 millimeters, laterals 7.0 millimotors, and on the 
lower, central 5.6 millimeters, laterals 6.1 millimotors and cuspids 
6.6 millimeters. In Fig. 2 (b), the teeth are arranged in a proper 
curvature to produce occlusion. It will bo noted that the summit of 
the cusps of the lower cuspids have occluded between the upper lateral 
and the cuspid. 



186 



ORAL HEALTH 




Fig. 2. 

In Fig. 2 (c), a curvature has been selected that is too flat for this 
individual, and it w^ill be seen that the lower cuspid is unable to reach 
its position in occlusion, and the summit of the cusp is mesial to its 
normal position in relation to the upper. 

In Fig. 2 (a), an arch that is too narrow has been selected and a 
curvature that is too sharp in the front, and in this case we are unable 
to get occlusion as the lower tooth material stretches too far in rela- 
tion to the upper, and the lower cuspid is seen to occlude distally to 
Its normal position. From this it will be seen that the occlusion of 
the teeth depends upon the inter-relation of the tooth sizes and forms, 
and that the Orthodontist, in taking a case of malocclusion, must 
realize that in order to predetermine the arch of any given case, he 
must in some way test the relations of these teeth to each other and 
f?nd out if occlusion can be produced, and if it can, what form the 
dental arch will assume when this individual's teeth are placed in 
their best relations to each other. 

By a careful study of Fig. 2, it will be noted that in these three 
plans (a), (b) and (c) of an arch, that the distal contacts of the 
upper laterals and the lower cuspids change their positions (as shown 
by the squares they occupy) a great distance, while their occlusial 
relations are only slightly disturbed. The necessity of selecting a 



ORAL HEALTH 



87 



proper width for bicuspids and molars is graphically shown by this 
figure if the reader appreciates how much the width and curvature 
of the side teeth influence the position and direction of the mesio- 
distal contact line of the lower cuspid as shown in (a), (b) and (c). 




Fig. 4A. 




Fig. 4B. 



This principle is well shown by examining Figs. 4 (a) and 4 (b). 
which are models of a treated case where a mistake has been mado 
m selecting the correct arch-form to produce occlusion. 

In Fig. 4 (a) we have a good relation of the side teeth with a 
space between the incisors. In Fig. 4 (b) we note the crowding and 
overlapping lower incisors. It follows that this arch is too narrow iii 
the bicuspid region. When an arch that is too narrow is selected, 
the result will be either a good relation of side teeth with overlapping 
lower incisors or a good relation of the upper and lower front teeth 
with an end to end relation of the side teeth. U'Ih'I} this principle is 
tlwroughlv understood, the use of inter-nuixilUirv elastics )rill become 
greatl)) dinunished. 



188 



ORAL HEALTH 




Fig. 5A. 




Fig. 5B. 

Fig. 5 (a) and 5 (b) has been selected to show the method of 
surveying and predetermining a mixed denture in malocclusion. The 
plan adopted has been to make maps of the malocclusion and to 
make maps of the proposed occlusion and by sliding the maps of 
occlusion over those of malocclusion, to select a position that vv^ill 
restore the teeth to occlusion w^'th the least tooth movement. 

Fig. 3. 

In Fig. 3 (a) the upper teeth are in red and the lower in black 
(the molars are surveyed on the summit of the cusps and connected). 
Buccal and lingual grooves are shown; (b) occlusion; (c) upper 
jaw, malocclusion in black, proposed positions in red; (d) lower jaw 
— the black to be moved to red; (e) upper gum line in black as sur- 
veyed from original model; red, finished gum lines when occlusion is 
established; (f) lower gum lines^ — the red moves to the black. 

In conclusion, the author wishes to make a strong plea for the early 
treatment of malocclusion for the following reasons: 

First, as the principal arrest of development comes before the erup- 
tion of any permanent teeth and is most markedly shown in the width 
of the dental arch in the region of the temporary molars, it is most 
disastrous to the permanent denture to leave the temporary denture 
untreated for the reason that the first permanent molars on eruption 
seek mesial contact with the deformed deciduous teeth. 



ORAL HEALTH 191 

Secondly, as the incisal portion of the permanent arch contains 
teeth that are, on the average, seven miUimeters larger than the tem- 
porary incisors, therefore the great deformities and disfigurements of 
the permanent denture are made by not moving the temporary den- 
ture into normal curvature so that the incisal teeth will erupt normally. 

Thirdly, as has been pointed out by many other writers, by moving 
the lateral halves of the temporary denture, the germs of the per- 
manent teeth contained between the roots of the temporary molars 
are moved to their correct position by the application of force to the 
temporary teeth. A fault has been in tying the lower incisors forward 
in an arch that is too narrow and too long for that individual. This 
fault is aggravated by retaining the lower incisors by means of lingual 
retaining appliances. On removal, the lower incisors would drop 
back and break contact with the upper arch. In this plan of treat- 
ment, the lateral halves of the arch will be moved into their correct 
curvature, permitting the incisors to erupt into their normal positions. 
Without retention they should remain in these positions. 

The next great advantage in treating the dental apparatus at this 
early age is the fact that the temporary denture is very nearly on a 
plane and that the appliances placed on the temporary teeth do not 
disturb this plane if the teeth are moved bodily. While the first 
upper permanent molar in its eruption has considerable vertical cur- 
vature, and as the permanent denture evolves, the curvature is con- 
stantly changing until the completion of the permanent denture. 
When the occlusion has been completed there is a slight upward 
curvature of the upper first molar. For this reason it is unwise to 
attach to the first permanent molar as it erupts and fix it rigidly with 
appliances that interfere with this changing vertical curvature. 

By applying force to the temporary denture by means of attach- 
ments to the temporary molars, we correct the tendency of the first 
permanent molar to erupt into too narrow an arch and we do not 
interfere with its vertical curvature, which is continually changing 
normally. Progress surveys can be made from time to time and 
compared with the original maps of occlusion and malocclusion. 



Last Instalment of Dr. Cummer's Article. 



UNFORTUNATELY, it has been found impossible to con- 
tinue Dr. Cummer's article, "Partial Dentures." in this issue. 
Arrangements have been made, however, to conclude the 
article in the June issue. 



The Sterilization of Dental Instruments.'' 



H. E. Hasseltine, Passed Assistant Surgeon, United States 

Public Health Service. 



THE possibility of the transmission of disease from one person to 
another through the medium of instruments and appHances used 
in dental operations has long been recognized. Reports of such 
occurrences are frequently heard from the laity, but authentic reports 
in scientific publications are practically never published. Few men 
will deny that such cases do occur occasionally ; their frequency, how- 
ever, is not determinable. 

Anyone familiar with asepsis has probably noticed errors in the 
surgical technique of a dentist while receiving dental treatment. 
Among these errors may be mentioned the placing of sterilized instru- 
ments on a swinging tray or glass plate which has not been sterilized, 
the cleaning of burrs on a scratch wheel which has not been sterilized 
since the burrs used on the previous patient have been cleaned thereon, 
and the frequent handling of the cable of the dental engine, which 
receives contamination from one patient through the operator's hands 
and in turn returns a portion of this contamination to the operator's 
hands when used on subsequent patients. These are some of the 
errors of technique seen personally, and are mentioned here to empha- 
size the necessity of having everything which comes in contact with 
the instruments or hands of the operator free from organisms obtained 
from previous patients in order to prevent transmission of infection 
from one patient to another. 

A sterile towel over the tray, a scratch wheel which can be removed 
and sterilized with the instruments, and a simple sterile linen cover- 
ing to put over the cord of the engine would make the operation many 
time more acceptable to the critic, provided, of course, a fresh towel 
and covering were used for each patient and the scratch wheel steri- 
lized when each patient vacates the chair. 

For improvement of the technique of the future dentists we should 
look to the dental schools. They all have courses in bacteriology, 
which, however, in many schools are largely theoretical instead of 
practical. The morphology and cultural characteristics of various 
organisms are considered, but their resistance to disinfectants is passed 
over by noting what certain books say regarding this phase of the 
subject. Little actual laboratory work is done to show the relative 
value of the sterilizing agents applicable in dentistry and how their 
efficiency is tested. As a result the student forms the opinion that any 
sterilizing agent is effective, and does not learn to check his steriHza- 
tion by bacteriological tests. For the coming dentists the improve- 

*Bulletin No. 101 of .the Hygienic Laboiatoiy, TJnited States Public Health 
Service. 



ORAL HEALTH 193 

ment should come through the schools. For those already in practice 
it must come through reading and exchange of ideas among the men 
of the dental and medical professions. 

Realizing the necessity of improvement, some members of the 
dental profession are striving to bring about better sanitary conditions 
in the offices of dentists at large; also among their patients, by teach- 
ing them oral hygiene. This work is most commendable, and to this 
end the officers of some dental societies have asked the Surgeon- 
General of the Public Health Service to work out a detailed method 
for sterilizing dental instruments and appliances, keeping in mind the 
important factors, simplicity, efficiency, and duration of the process 
of sterilization. As a result of this request the writer was designated 
by the Director of the Hygienic Laboratory to consider the matter, 
make experiments, collect data, and make a report thereon. 

The progress of the work has been interrupted frequently by 
exigencies of the service and the report much delayed as a result. 

The Sterilization of Dental Instruments. 

In considering this subject the writer has endeavored to keep within 
practical bounds rather than to pose as an idealist. 

In testing the efficiency of various methods of sterilization of dental 
instruments, the consideration of spore-forming organisms has been 
disregarded. A high degree of heat for a prolonged period is required 
to kill the spores of spore-bearing pathogenic organisms. Fortunately, 
the number of such organisms is comparatively few. The vegetating 
forms of these organisms are killed as easily as are the non-spore 
bearers. The spore represents a defensive element of the organism 
against unfavorable influences; that is, though capable of becoming 
alive, it is apparently in a lifeless phase. Since it remains in the 
spore stage while in conditions unfavorable for its growth, the spore 
is easily removed from place to place by mechanical means, thereby 
increasing the chance of finding a more suitable environment. 

By reason of this fact mechanical means of removal of spores from 
instruments is relied upon. Mechanical cleansing of instruments by 
a brush or sponge, preferably in running water, will reduce the 
number of spores so that the number remaining will be too small to 
consider. For experimental data on the efficiency of mechanical 
cleansing in the removal of spores, the reader is referred to Francis ( I ). 

Such organisms as the pus-producing cocci, the bacillus of tvphoid 
fever, the bacillus of diphtheria, the bacillus of tuberculosis, the 
Treponema pallidum (syphilis), the bacillus of influen/a. the amoebae, 
and the thrush fungus, are known organisms that should be considered. 
To this list may be added the virus of diseases of unknown or uncer- 
tain origin, such as that of measles, scarlet fever, mumps, infantile 
paralysis, and smallpox, all of which seem to be caused by non-spore- 
bearing organisms. 



194 



ORAL HEALTH 



Of the non-spore-bearing organisms, the staphylococci are reported 
to be the most resistant to heat, our most efficient disinfecting agent. 
On this account various strains of staphylococci were used as the 
test organisms in the experiments made in connection with this 
investigation. 

Table I.— Showing thermal death point of various organisms according to 

different authorities. 



Autluirit.v 



Stern burs (21. 



MfFarland (',)) 

Mniraiul Ritchir (4) ... 
Park and Williams (5). 

Hiss and Zinsser ((>) 

Jordan (7) 

Abbott (8) 

Rosonau (9) (10) 



Intluon/.a 



()0°. 5 niiniitos. 



()0^, 5 minutes 

60°, few minutes, 



60<=, 10 minutes. 



Staphylococcus 
aureus 



\ Moist. 58°. 10 
miniites. 

/Dry. 100° 

I 62°, 10 minutes. 
1 l-2minut's 
30 minutes. . 
5 minutes. . . 
10 minutes.. 
1 Dry, 90 to 100°... 
80°. 30 minutes.. 
62°, 10 minutes.. 



180°, 
80°, 
80°. 

158^ 



Streptococcus 



54°. 10 minutes. 



54°, 10 minutes. 
I 54°, 10 minutes. 



54°, 10 minutes. 
54°, 10 minutes. 



Pneumococcus 



52°, 10 minutes 



52°, 10 minutes 

52°, 10 minutes 
52°, 10 minutes 



Authority 



Sternberg (2) 

Mci\irland (3) 

Muir attd Ritchie (4)... 
Park and Williams (5). 

Hiss and Zinsser (6) 

Jordan ("i ) 

Abbott (8) 

Rosenau (9) (10) 



Meningococcus 



Readily 

j Kxtr'm'ly sen- 
) sitive to heat 



Typhoid 



56°, 10 minutes. 
60°, 10 minutes. 
60°, 30 minutes. 
60°, 1 minute... 

56°, 10 minutes. 



60°, 10 minutes. 
60°, 20 minutes 



Diphtheria 



58°, 10 minutes.. 
58°, 10 minutes.. 
60°, 10 minutes.. 
60°, 10 minutes. . 

58°, 10 minutes.. 

55°, 45 minutes. . 

58°. 10 minutes.. 

Less than typhoid 



Tubercle bacillus 



70°. 

60°. 

70°. 

80°. 
(60°. 
180°, 

60°, 
j80°, 
)65°, 

60°, 



10 minutes 
20 minutes 
1 hour 
1 minute 
20 minutes 
6 minutes 
20 minutes 
5 minutes 
15 minutes 
20 minutes 



Table I. shows the thermal death point of various organisms, 
according to different authorities on bacteriology. It was found that 
the stock laboratory cultures of staphylococci were much less resistant 
than strains of the same organism obtained from human beings. For 
this purpose smears from cases of suspected diphtheria or from cases 
of tonsilitis were used, thereby getting organisms similar to those 
encountered in the mouth. Mixed cultures were used to simulate the 
conditions found in nature. In a few cases. Bacillus subtilis, a non- 
pathogenic spore-forming organism was encountered. 

The resistance of the staphylococci was also tested, when dried on 
instruments prior to sterilization and when not dried. The resistance 
was always greater when the contaminated instruments were dry. 
Consequently the dried infectious material was used in most of the 
tests. 

The physical processes involved in sterilization have been the sub- 
ject of much research and discussion. It is not necessary to consider 
here to any extent the theories. They can be stated briefly as the 
coagulation and hydrolytic theories. The first strives to show that 
the cell substance of the organism is coagulated by the disinfecting 
agent, just as the white of an egg is coagulated by heat when cooked. 
The second theory claims that the death of the organism is brought 
about by the introduction of water into the cell substance, the conse- 



ORAL HEALIH 



195 



Thermal 



quent hydrolysis being accelerated by the disinfecting agent. 

The process of sterilization has been described by Phelps (11) as 
an increase of the death rate of organisms. But in determining the 
result of this process there are three factors to be considered, viz : 
(a) The velocity of the death rate of the organisms; (b) the time 
through which (a) is allowed to proceed; (c) the number of organ- 
isms present. The product of these three factors gives the result. 
Sterilization is, therefore, a relative result from a mathematical view- 
point and is usually arbitrarily recorded as perfect when the number 
of bacteria in the volume tested is less than one. On this death rate 
of organisms, the number present, and the time allowed, depend the 
efficiency of a sterilizing agent. 

However, the exact mode of killing the organisms does not interest 
the practising dentist and surgeon so much as does the assurance that 
all will be killed, in some manner, under certain conditions. 

The methods of sterilization employed at present in most dental 
offices may be classified as follows: 

Carbolic acid, iollowf-d 
by alcohol. 

Othf^r coal-tar products, 
followed by alcohol. 
Chemical Formaldehyde vapor in a 
tisht chamber. 

Other chemicals, such a.^- 
sasoline. solution of 
biniodide of mercury. 

The efficiency of most of these methods was tested, and the advan- 
tages and disadvantages of each considered. 

Boiling in Water 

Results of experiments. — Most authorities state that non-spore- 
bearing organisms are killed by boilmg for 10 minutes. A few have 
reported organisms of this class that have resisted boiling for 30 to 60 
minutes, but such are of too infrequent occurrence to require consid- 
eration. Of the various strains of staphylococci in mixed culture. 
which I have tested, I have found none that survived three minutes 
boiling. This means exposure to water heated until noticeable ebul- 
lition takes place before the organisms arc placed therein, the time 
being taken by the watch. Undried instruments were sterilized i.i 
two minutes. Sterility tests were made by dropping the sterili'CvH 
instruments into tubes of nutrient bouillon and incubating these for 
48 hours at 37 . Though my experiments show stonli/ation in a 
shorter time, a period of 1 minutes' boiling is recommended, to pro- 
vide an ample margin on the side of safety. A small amount of 
alkali, such as sodium carbonate, or sodium hydroxide, should be 
added to the water to prevent rusting of instruments. 

Ihe advantages of this method are: (a) It is the most rapid and 
most efficient; (b) it is always available where fire and water can be 



Boiling in water. 
Use of boiling" water. 
Passing an instrument 

through a free flame. 
Moist heat in a closed or 

open chamber. 
Dry heat in a closed 

chamber. 



196 ORAL HEALTH 

obtained; (c) the procedure is simple and can be carried out by any 
one; (d) the expense of sterilization by this method is small. 

The disadvantages are: (a) Dulling of the sharp edge of cutting 
instruments, such as knives, lancets, etc.; (b) increase of effect of 
action of any chemical impurity in the water upon the instruments, 
a factor that will vary according to local conditions. 

Use of Boiling Water. 

Results of experiments. ^\{ used immediately after the heat is cut 
off, and in quantity sufficient to guard against a rapid cooling, this 
method is nearly the equivalent of boiling, so far as practical results 
are concerned. The use of one gallon of water, boiled until the 
moment before the instruments are submerged in it, sterilizes as 
rapidly as does boiling, at least during the first five minutes of ex- 
posure. If care be taken to carry out this procedure fully, the method 
is efficient, the advantages and the disadvantages being the same as 
with boiling, save that the rapid cooHng of the water will necessitate 
reheating to the boiling point to insure proper results. 

The use of water of too low temperature or for too short a period 
of time makes possible incomplete sterilization. As the temperature 
is lowered the period of 'exposure must be lengthened ; but, as the 
loss of heat is uncertain, the required length of exposure will neces- 
sarily be uncertain. On account of the uncertainty of the tempera- 
ture of the water, except it be boiled immediately prior to use on each 
occasion, this method is not as good as boiling or the use of a l^nolvn 
temperature at a degree lower than the boiling point. 

Passing an Lnstrument Through a Free Flame. 

This method is effective, since, if properly carried out, it virtually 
amounts to incineration of the organisms. The degree of heat to 
which the instrument is subjected is much higher than the boiling 
point, and on this account only a few instruments can be sterilized 
by this method without interfering with cutting qualities, temper of 
steel, or plating of instruments. It is applicable to certain small 
instruments whose cost is not high, but is not available for general 
use. 

Moist Heat in an Open or Closed Chamber. 

This is applied by the use of steam in an open chamber (Arnold) 
or in a tight chamber under pressure (autoclave). Its use for instru- 
ments is not very extensive, as the same results can be obtained by 
direct boiling and some time saved, since boiling a small amount of 
water requires much less time than heating up a large apparatus. It 
]s of greatest value for sterilizing linens, gowns, towels, etc., and the 
steam under pressure is preferable, on account of its greater pene- 
tration. 



ORAL HEALTH 197 

Dry Heat in a Closed Chamber. 

This method is not used for instruments, on account of the high 
temperature required and the long time required to carry it out. It 
can be used for glassware or for sterilizing linen, if the temperature 
be not too high. 

Use of Carbolic Acid Followed by Alcohol. 

This method consists of submersion of the instruments in phenol 
of varying strength. The solubility of phenol in water is about 1 
part in 20, giving a 5 per cent, solution. This solution is more effec- 
tive than the pure phenol. After submitting the instruments to this 
treatment they are immersed in alcohol, to remove the excess of 
phenol, and may then be rinsed in water, or used without rinsing. 

Results of experiments. — With many strains, 10 minutes' exposure 
to 5 per cent, phenol, followed by one minute in alcohol, sufficed to 
sterilize. Some strains of staphylococci, however, were more resistant 
and uniformly gave growth after 15 minutes; in a portion of the tubes 
even after 30 and 45 minutes' exposure. No strain used survived one 
hour in 5 per cent, phenol. The same resistant strain was uniformly 
killed by boiling for three minutes. It was also killed by three min- 
utes' exposure in an 80° water bath. 

Its advantages are: (a) The cost is moderate; (b) it can be ap- 
plied to practically every instrument and appliance without damage 
resulting therefrom. 

Among its disadvantages are: (a) It requires a longer period of 
time to sterilize; (b) it requires more care in the application of the 
method (care must be taken to see that all surfaces of instruments 
are exposed to the solution) ; (c) instruments must be removed from 
phenol by forceps, as the solution has a bad effect on the skin if the 
hands are used in it frequently; (J) it requires a much better trained 
assistant, or the attention of the dentist himself, to use this method 
properly; (e) the odor of phenol is, to some, objectionable. 

The use of other coal-tar products resembles that of phenol in 
application and efficiency. The advantages and disadvantages men- 
tioned under phenol apply also to these products, except as follows: 
(a) Some have a higher co-efficient than j^henol; that is, they are 
more germicidal than phenol; (b) some have a soapy composition, 
giving them the cleansing property of soaj) when mixed with water; 
(c) their cost, however, is in most cases considerably greater. 

Formaldehyde Gas in an Air-tight Chamber. 

This method has, of late years, been very popular among dentists 
and is efficient, provided a sufficient length of time is allowed for 
action. 

Results of experiments. Fxposure of contaminated mstrunionts to 
formaldehyde vapor in an air-tight glass jar for periods varying from 



198 ORALHEALTH 

10 minutes to one hour gave growth more or less constantly. Some 
strains of staphylococci were always killed by 30 minutes' exposure; 
the more resistant strains survived for 60 minutes. An exposure of 
one and one-half to two hours killed the most resistant strain used. 
These results were obtained with an excess of formalin in a small 
glass jar closed by ground-glass joints sealed with vaselin, so the air 
was filled to saturation with the formaldehyde vapor. 

The advantage of this method lies solely m its simplicity and ease 
of application. 

Its disadvantages are: (a) The time required to sterilize is too 
long for a busy dentist; (b) formaldehyde causes quite a marked 
rusting of unplated steel instruments; (c) inefficiency is likely to result 
from the lessening of the density of formaldehyde vapor, unless special 
care be taken to replenish the supply of formalin solution at frequent 
intervals; (d) inability to remove a single instrument from the air- 
tight chamber without interfering decidedly with the process of steri- 
lization, because of the lessening of the density of the formaldehyde 
vapor in the chamber; (e) the disagreeable odor and irritating effect 
on mucous membranes will be experienced more or less by both oper- 
o.tor and patient. 

Other Chemical Methods. 

Disks containing mercuric iodide with some alkaline salt are 
theoretically practicable. The alkalinity is supposed to guard against 
the corrosive action of the mercury on the metal instruments. How- 
ever, this brings a rather delicately balanced chemical reaction into 
use, and unless the application of the method be carried out by the 
dentist himself, or an assistant who has some knowledge of chemistry, 
bad results may be obtained. For instance, the chemical impurities 
of the water used may vary from day to day, and thus disturb the 
proper degree of alkalinity. No experiments were made with these 
disks, as it is not conceivable that their use is an improvement on some 
of the simpler and less technical methods. 

The action of various chemical substances, such as gasoline, 
petroleum-ether, etc., was tried by the writer. Their efficiency is 
doubtful and uncertain. No sterilization was obtained except on 
prolonged exposure (24 hours or more). 

In addition to these methods the writer tried the application of 
moist heat at a constant degree, lower than the boiling point; 80 
was the temperature used. This was tried in order to get a method 
that would interfere less with the edge of cutting instruments than 
does boiling; also, a method that could be applied to certain instru- 
ments that could not be boiled without marked deleterious effect on 
them, such as dental mirrors. 

A jacketed water bath, designed by Mr. W. F. Wells, which was 
equipped with an apparatus for maintaining a constant level of water 
in the jacket, was used for this purpose. The inner chamber contains 



ORAL HEAL IH 199 

a thermoregulator set at 80 . In this bath the contaminated instru- 
ments were placed for varymg periods. 

To alkalinize the water. 0.23 per cent, sodium hydroxide was 
added. \\ hen once raised to 80 . the amount of gas or electric cur- 
rent required to maintain a bath containing one to two gallons is very 
small, indeed. In fact, it can be maintained at that temperature for 
the whole 24 hours cheaper than it can be extinguished and reheated 
each day. 

The use of this degree of heat had no deleterious effect on metal 
instruments or dental mirrors after prolonged and repeated exposure. 
Sterilization was always obtained in three minutes, even with the 
most resistant strains of staphylococci used. It is thus seen that this 
is practically as effective as boiling, but the temperature is 20 lower. 
It is simple to operate when once installed and is very efficient and 
rapid. 

As stated above, no bad effects were noted on dental mirrors or 
instruments. However, there was a bad effect on instruments with 
wooden or hard-rubber handles. In the present era. however, no 
instrument that is not entirely of metal has any place in the arma- 
mentarium of surgeons or dentists. There are a few exceptions to 
this rule, where flexibility or elasticity is a factor in the use of the 
mstrument. 

From the above experiments and considerations the methods de- 
pending upon moist heat were found to be by far the most rapid and 
efficient. 

In order of merit the writer places the methods depending upon 
heat as the active disinfecting agent as follows: 

1. Boiliiii: for at least 10 minutes in (.'.25 per cent, sodium hydroxide. 

2. Use of water bath at SO' for at least 10 minutes. 

3. Use of moist heat in free chamber (Arnold sterilizer) for at lea.sr 
10 minutes after thermometer reaches 100°. 

4. Submersion in boiling: water for at least 10 minutes, the source of 
heat beins: removed immediately prior to submersion of the instrument. 

5. Application of dry heat by passing instrument throusrh a free tiame. 

6. Dr>- heat in closed chamber. 

The arrangement of the chemical methods in order of merit is much 
more difficult: in none are simplicity, efficiency, and rapidity com- 
bined as in some of the methods dependent on heat. 

Using formaldehyde, the simplicity is ideal: but the length of 
exposure necessary to gain efficiency makes it undesirable. With 
phenol and other coal-tar products efficiency is good but simplicity 
and rapid'ty are partially sacrificed. ^X ith mercuric iodide, the same 
factors that militate against phenol, jilus a possible deleterious action 
on the instruments, are applicable. 

It is the opinion of the writer, therefore, that in selecting a method 
for adoption in dental offices the use of moist heat is essential. 5y>me 
will offer the objection that a dentist has many instruments which will 



200 ORAL HEALTH 

not stand such procedure. I will admit that there are, perhaps, a 
few instruments which can not be boiled without an injurious effect 
on them; but after eliminating hard rubber and wood handled instru- 
ments, which have no place in any instrument case of the present age, 
this list becomes very small. 

I shall now consider the method of choice as applied to different 
instruments. 

The instruments in the following list can all be boiled without 
marked bad effects unless the water used has some special chemical 
impurity which attacks the metal. Such conditions will have to be 
determined for each water supply and the proper remedy sought 
through scientific channels. 

Broaches and their holders. Mouth gags. 

Burnishers. Mouthpiece of gas apparatu.s. 

Burrs. Mouthpiece of saliva ejector. 

Chisels. . Pluggers. 

Cone-socket instruments with metal Polishing points. 

handles. Pyorrhoea instruments. 

Drills. Root elevators. 

Excavators. Rubber-dam clamps, and forcep:^ 
Explorers. for the same. 

Files. Rubber-dam holder (metal parts) 
Forceps, extracting. and weights. 

Forceps, foil. Saws. 

Forceps, tongue-holding. Scissors. 

Impression trays. Scalers. 

Knives and lancets. Spatulas, metal. 

Mallets, automatic and hand. Syringes, water. 

Mixing slabs. Syringes, hypodermic. 

The latter should be of glass or metal without washers; they can 
then be boiled repeatedly without impairing their efficiency in any 
way. An inferior hypodermic syringe is always unsatisfactory, 
whether it be sterilized or not. 

To the above list I will add the following as instruments that will 
stand boiling: 

Chip blower. Wire scratch wheel for head of 

Masks for giving nitrous oxide gas. dental engine. 

Engine hand pieces. 

The wire scratch wheel on the head of the dental engine should be 
made entirely of metal and detachable, so that it can be easily re- 
moved and boiled. Probably a cheap bristle wheel might be made 
that could be discarded after each patient is treated. 

Probably many will challenge the statement that engine hand 
pieces can be boiled. This statement is made only after having pro- 
cured a right-angled hand piece, boiled the same, and tested its 
sterility, then contaminated it with a fluid culture of bacteria, and 
again boiled it and tested its sterility. After completing the experi- 
ments with it for the day it was placed in 95 per cent, alcohol to 
remove the excess of water, and in several instances left in this fluid 



ORAL HEALTH 201 

overnight. It has been boiled repeatedly and frequently exposed to 
80° in a water bath, yet it has shown no bad effects as a result of 
such treatment, except the removal of the lubricant from the mechan- 
ism. It can be oiled in a few seconds and its mechanism will run as 
smoothly as before. These hand pieces could be made with oil holes 
at the proper points so that the oiling would be much facilitated. 

This instrument is one which dentists have usually considered non- 
sterilizable, consequently it has received very little efficient steriliza- 
tion. Marshall (12) states that hand pieces can be sterilized by 
immersing them in gasoline and then in alcohol; but my experiments 
with sterilization by anhydrous liquids have given disappointing re- 
sults, even with instruments of simple construction. Furthermore, the 
effect of gasoline and alcohol on the lubricant will be practically as 
complete a removal of the oil as when boiled, so that oiling of the 
piece would be necessary after each sterilization. 

In sterilizing hand pieces, heat will reach infection in parts of the 
instrument where cold solutions can not be effective, on account of 
the oil present, and where gas does not penetrate. With heat, the 
metal itself is raised to the temperature of the surrounding medium, 
so that the organisms are attacked from all sides; while with solu- 
tions or gases more or less of their surface is protected. 

In seeking a method of sterilization for hand pieces, several methods 
were tried, designed to obtain sterilization without the introduction 
of water into the instrument. As stated above, the gasoline method 
d'd not sterilize rapidly and completely. Immersing in a fixed oil, 
liquid vaseline was then tried, placing this in a steam chamber and 
raising the temperature to 100 for one hour. This proved inefhcient, 
because the heat is only the equivalent of 100 of dry heat, the in- 
strument being in an anhydrous fluid. As a last resort I turned to 
moist heat by the method of boiling, or an 80 water bath, in 0.23 
per cent, sodium hydroxide and then removed the excess of water by 
absorbing it with alcohol. This gave the desired result. 

All of the above mentioned instruments may be submitted to 80 
in a water bath without any injurious effect on the instruments. 
Mouth mirrors may also be sterilized by this method without injuring 
them. This was determined by obtaining several new mirrors, con- 
taminating them, and then placing them in 0.25 per cent, sodium 
hydroxide solution at 80 . Sterilization was accomplished in three 
minutes, though the mirrors were frequently left in the bath for a 
much longer period, 10 to 60 minutes. The test of the effects of this 
treatment was made by handing the sterilized mirrors, together with a 
new mirror of the same lot that had not been sterilized, to other per- 
sons and asking them to pick out the one that had not been sterilized. 
Everyone acknowledged his inability to determine any difference. 

Boiling, or heating to 80 , the rubber bulbs of chip blowers, and 
the face piece of the gas inhaler, will shorten the life of these articles. 



202 ORALHEALTH 

It is believed, however, that the increased expense, due to these rub- 
ber fittings, will not be great enough to work any hardship on the 
dentist. It certainly will not be as great as the cost of rubber gloves 
used by the average surgeon; and at present nearly every surgeon 
uses rubber gloves and insists on their sterilization by boiling. The 
dental surgeon should not be content with a lower grade of work, nor 
deterred by the small sum necessary to replace articles which have 
been worn out a little sooner by reason of improved methods in his 
practice. 

The instruments considered above, which can be sterilized by boil- 
ing, include the greater portion of those used by the dentist; except 
those whose cost is so slight, or whose usefulness so impaired after 
using once, that they can be thrown away. 

This list includes: 

Polishing: points and disks. 

Rubber dam. 

Nerve broaches (these may be sterilized by heat if desired). 

Bristle brushes. 

Mounted stones must be treated according to their construction 
and composition. Carborundum disks, wheels, and stones, which are 
bonded with porcelain, can be boiled without injury. Those made 
with rubber as the adhesive base can not be heated. Their steriliza- 
tion can be accomplished by use of a phenol solution followed by 
alcohol. Corundum stones can not be boiled, so the phenol solution 
fhould be used on these. Stones mounted on a mandrel by a cement 
or shellac can not be subjected to heat, while those mounted by metal 
devices can be boiled, provided their composition allows such treat- 
ment. Inasmuch as many of the stones and disks must be steriHzed 
without heat, it is permissible to sterilize all stones by immersing in 
5 per cent, phenol solution for one hour, to be followed by immersion 
in alcohol to remove the excess of phenol solution. 

Tortoise shell, and instruments of similar composition, which 
might be injured by heat, should be immersed in phenol solution, as 
are mounted stones. Mouth mirrors may also be sterilized in this 
manner, if not subjected to 80°. 

The life of a mouth mirror, however, depends entirely on the 
efficiency of its construction in keeping fluids of any kind from the 
amalgam surface of the glass. As long as this can be kept dry the 
mirror is clear. When it becomes wet by any fluid, either water or 
saliva, it becomes cloudy, consequently a well-constructed mirror is 
the cheapest in the end. 

This method may also be applied to instruments whose composi- 
tion must be other than metal, on account of the discoloring effect of 
metal on cement, or for other good reason. 

However, barring the few instruments whose chemical composi- 
tion is such that a serious change in character would result from 



ORAL HEALTH 203 

heating, all instruments should be sterilized by heat, and no instru- 
ment made of material that is destroyed by heat should be allowed 
in the instrument case, if the same instrument can be made of ther- 
mostabile matter. 

I have seen some dental instruments with rubber handles which 
have been boiled repeatedly, with no bad effect except discoloration 
of the rubber. These, however, had a central metal shaft sujjporting 
the rubber, to prevent bending when heated. While this construc- 
tion permits the boiling of rubber-handled instruments, it can not be 
said that rubber handles are as acceptable from an aseptic xiew- 
point as are all-metal instruments. Of course, instruments whose 
cost is so slight that they are used once and then discarded do not 
require sterilization to prevent transfer of infection from patient to 
patient. 

Other Sanitary Measures. 

The following suggestions relating to dental asepsis, while not 
strictly within the subject of sterilization of instruments, are given as 
contributory factors m improved office sanitation. 

Cuspidors are a necessity in a dental office, and the problem of 
keeping them in sanitary condition is a difficult one. The installation 
of the fountain cuspidor has been a great improvement over the old 
metal or earthen bowls which were so hard to keep clean. To those 
dentists who still have the old type of cuspidor, on account of lack 
of running water or for other reason, I would recommend at least 
daily cleaning, with a broom or stiff brush and water. This is to be 
followed by placing the cuspidor in a bucket, covering it with boiling 
water, and leaving it there for at least one hour. It would be well 
to have several of these, so that a clean one can be put in use for each 
patient while the others are being cleansed by assistants or char- 
women. In offices having the single-bowl fountain cuspidor, with 
bowl that can not be removed, flushing with hot water and antiseptic 
solutions is our main effort in sterilization. All fountain cuspidors 
should be fitted with both hot and cold water, so that the hot water 
can be used for cleaning the bowls after each patient is dismissed. 
Those having bowls that can be removed can have the bowls im- 
mersed in antiseptic solutions, or may even be boiled in a large con 
tainer. However, absolute sterility of cuspidors is not of vital impor- 
tance, provided a high degree of cleanliness is maintained. It is well, 
however, to have these articles of equipment installed so that com 
plete sterilization can be carried out in case an unusual infection. 
such as diphtheria, is encountered. 

The possibility of the operator transferring infection to the cable of 
the dental engine above the hand piece, and then later from the cable 
to another patient, has been mentioned. If the cables have the power 
transmitting mechanism inside a covering, this can be avoided by a 
simple sterile or clean cotton sleeve, with a draw string in each end. 



204 ORAL HEALTH 

which can be slipped over the cable and tied after the hand piece is 
in place, so that the whole cable is covered down to the sterile hand 
piece. This allows the operator to handk the cable at will during his 
operation, and, when a second patient is treated, a second clean 
sleeve is put on in place of the first one. It is also probable that a 
flexible metal covering, of tubing such as is used for conducting gas 
to lamps, might be constructed so that this could be removed and 
sterilized by heat. This is not applicable to engines which transmit 
the power from engine head to hand piece by open cord belt. 

The use of foot levers for turning on the flow of hot and cold water 
in the washbowl is a great convenience to a busy operator who desires 
to keep his hands sterile. The use of a clean washable covering for 
the operating chair is a step in the direction of asepsis and cleanli- 
ness. The headrest should have a clean linen cover, renewed for 
each patient. 

There should be toilet facilities for patients and, in addition to the 
usual lavatory equipment, a dental bowl, like that seen on Pullman 
cars, so that a patient may brush his teeth without doing so over the 
washbowl. 

To place the patient's mouth in as clean condition as possible, 
each patient should brush his teeth, preferably immediately prior to 
coming to the chair. This should be followed by a thorough rinsing 
of the mouth with some good mouth wash. This procedure is a 
mechanical cleansing, aimed primarily at the removal of spores from 
the field of operation, though many other organisms are removed at 
the same time. 

In order to do this the dentist should have a supply of tooth- 
brushes on hand and, if necessary supply a new brush to each 
patient. This may be the patient's first encounter with the oral 
hygiene educational movement, but I beHeve it will be productive of 
good. I believe that the dentist should add the cost of the brush to 
the patient's bill, unless brushes can be obtained at so low a figure 
as to make their free distribution practicable. A supply of mouth 
wash should be on hand in a convenient place for use by patients. 

Paper drinking cups and paper, or small individual, towels for 
patients should be furnished. The common drinking cup and towel 
are abolished on all interstate carriers, and in hotels and public places 
in many States. It is, therefore, fitting that the members of the 
medical and dental profession should apply the spirit of these laws 
to their own establishments, even though the letter of the law does 
not require it. 

Clean linen direct from the laundry is not sterile, but offers only 
the remotest chance for transmission of infection through it. Sterile 
linen is desirable and for a busy dentist, apparatus for its steriliza- 
tion will be a great addition to office equipment. Steam pressure 
sterilizers are preferable for this, though other types may be used. 



ORAL HEALTH 



205 



Summary. 
As a result of the experiments and investigations detailed above 
the w^riter reaches the following conclusions and recommends the 
follow^ing methods for sterilization of dental instruments: 

Conclusions. 

1 . Moist heat is our best disinfecting agent for the sterilization of 
all metal instruments. 

2. For the destruction of non-spore-bearing bacteria, moist heat 
at 80° is nearly as efficient as boiling, and for practical purposes can 
be used in place of boiling. 

3. Instruments constructed of metal, whose complicated mechan- 
ism has heretofore caused them to be considered as non-sterilizable, 
can be sterilized by moist heat, provided the water is removed from 
them by immersing in alcohol subsequent to sterilization. 

4. Instruments, whose construction does not permit of boiling, can 
be sterilized by chemical disinfectants. 

5. There is need for more practical instruction in dental schools 
and clinics in the methods of sterilization, and the subsequent testing 
of the same by bacteriological methods. 

6. Dentistry, which is a highly specialized branch of surgery, 
should use the two factors, asepsis and anaesthesia, which have made 
possible the wonders of modern surgery, with skill and precision equal 
to that of surgeons. 

Recommendations. 

1 . That all instruments and appliances be rendered mechanically 
clean by washing in water with a brush or sponge. 

2. That the following instruments and appliances be boiled or 
submitted to 80° in a slightly alkaline solution (0.25 per cent sodium 
hydroxide) : 



Artificial teeth used in matching 

and measurin.^. 
Broaches and their holders. 
Burnishers. 
Burrs. 

Chip blowers. 
Chisels. 
Drills. 
Excavators. 
Explorerr.. 
Files. 

Forceps, extracting. 
Forceps, foil. 
Hand pieces tor engine. 
Impression trays. 
Knives and lancets. 
Mallets, hand and auloniatic 
Mixing slabs. 
Mouth gags. 
Mouthpiece of saliva ejector. 



Pliers. 

Pluggers. 

Pyorrhoea instruments. 

Polisliing point. ^ and l)rusli«\s (if 

not discarded after usine one*'). 
Reamers. 
Root elevators. 
Rubber dam clamps and forceps for 

same. 
Rubber dam weights and metal 

parts of lu)l(lei-. 
Saws. 
Scalers. 
Scissors. 

Scratch wIkmI on 1m ;ul of engine. 
Spatulas, metal. 
Syringes, liypod«'rmic. 
Syringes, water. 
Tongue-holding forcep.^. 
Mirrors (if SO bath be used, but 

not to be boiled). 



206 ORAL HEALTH 

3. That instruments in the above Hst whose mechanical construc- 
tion makes it difficult to remove the excess of w^ater are to be placed 
in 95 per cent, alcohol for 10 minutes to remove water, then removed 
and allowed to dry. 

4. That only instruments with metal handles be used by dentists 
desiring to follow this method. 

5. That the following instruments be sterilized by immersion in 5 
per cent, solution of phenol for at least 60 minutes: 

Mounted stones. 
Tortoise-shell instruments. 
Mirrors (when 80° bath is not used). 

Other instruments not of metallic nature and which can not be re- 
placed by metallic instruments. 

6. That instruments, after using, be placed in a fluid medium, 
preferably clean water, to avoid drying of infectious material and to 
facilitate their mechanical cleansing. 

7. That no instrument or appliance, used on a patient directly or 
mdirectly, be used on any other patient until recommendations 1 and 
2, or 1 and 5, as the case may be, have been complied with. 

Bibliography. 

1. Francis, E. Laboratory studies upon Tetanus. (Hyir. Lab Bull 
No. 91, p. 70.) 

2. Sternberg, George M. Text Book of Bacteriology, 1901. 

3. McFarland, Joseph. Text Book upon the Pathogenic Bacteria, 1909. 

4. Muir and Ritchie. Manual of Bacteriology, 1907. 

5. Park and Williams. Pathogenic Microorganisms, 1914. 

6. Hiss and Zinsser. Text Book of Bacteriology, 1914. 

7. Jordan, Edwin O. General Bacteriology, 1909. 

8. Abbott, A. C. Principles of Bacteriology, 1901. 

9. Rosenau, M. J. Disinfection and Disinfectants, 1902. 

10. . Hygiene and Preventive Medicine, 1912 

11. Phelps, Earle B. J. Infect. Dis., Chicago, 1911, 8: 27 

12. Marshall, J. M. Items of Interest, New York, 1912 35-765 



Education: The Social Instrument. 



THE foundations of health education must be laid in the schools. 
This is of particular importance in the light of our modern con- 
ception of health work. In our more advanced communities we 
scarcely need speak longer of public health work. It is possible now 
to drop the word 'public" and to talk of health. This means that 
personal health, personal hygiene, is to be the keynote of modern 
sanitation. The schools are, beyond comparison, the most valuable 
instruments for the instruction of society's members in the matters of 
hygiene.— Donald B. Armstrong, M.D., American Journal of Public 
Health, December, 1915. 



Some New Features Shown at the Dental Manufacturers' 
Exhibit, Chicago, April, 1916. 



By a Canadian Dentist. 



THE manufacturers of dental appliances and supplies deserve 
credit for the progressive spirit shown in developing new pro- 
ducts designed to make the work of the dental surgeon more 
efficient. The progress of dentistry, as it has occurred in the past, 
has been markedly influenced and assisted by the dental manufac- 
turer. Whether it be filling material or instrument or article of fur- 
niture, a high standard of quality has been set, and this has materially 
assisted the dental surgeon in the work of his profession. To eliminate 
the work of the dental manufacturer from modern dentistry would 
be to turn back the wheels of progress to an appreciable extent, and, 
while members of the profession frequently feel that the manufacturer 
has many times shown a lack of consideration for the dentist, there 
is little doubt that the dentist has just as frequently shown a lack of 
consideration for, and appreciation of, the work of the dental manu- 
facturer. 

Interchangeable Teeth. 

For instance, few dentists realize the amount of labor entailed in 
the production of an interchangeable tooth. It is physically impos- 
sible to build up a porcelain tooth, composed of different mixes of 
porcelain, to give the desired color and consistency, and which, after 
fusing, will be exactly like the original mould. In other words, simple 
fusing and interchangeability are impossible. This is due to a num- 
ber of reasons. To commence with, there is a shrinkage in baking of 
from 26 per cent, to 40 per cent. Distortion is also another feature 
to be considered. This latter may occur simply by the opening of 
the furnace door and the consequent flow of a current of cold an. or 
the teeth being fused on an asbestos tray covered with granular silex 
may be distorted by any slight unevenness in the bed of silex. causing 
a sagging of the biscuit. Then, again, the simple [process of closing 
the mould frequently exerts an uneven pressure with consecjuent 
distortion. 

These distortions are impossible to prevent, and they must, tlu-if 
fore, be removed by machine grinding after the porcelain is baked 
This grinding is accomplished by a diamond i)owder mounted on 
steel and copper alloy instruments. First the back of the facing is 
ground flat to a microscopically j^redetermined distance from the 
centre of the hole and made parallel with the hole. I he back of the 
facing having been made flat and parallel, the next step is to centre 
the slot, grinding it out to its proper width and extending it to its 
proper depth in relation to the incisal edge of the tooth 1 his centres 



208 ORAL HEALTH 

the slot perfectly and brings the operation to the stage of standard- 
izing the hole. This is accomplished by diamond-charged drills 
mounted on a multiple spindle machine. Thus in making an ordinary 
Steele facing the tooth passes through four processes and seven 
operations. 

1st. — Flat grinding. 

2nd. — Standardizing of slot. 

3j-d. — Standardizing of hole, consisting of four operations. 

4th. — Sizing the tooth. This process tests out all dimensions of 
the tooth in relation to each other and discovers and corrects 
automatically any inaccuracies or imperfections. 

The backing has, of course, to be made just as perfect as the tooth, 
for unless the tooth is properly supported by the backing, maximum 
strength is not attained. The backing is put through seventeen dis- 
tinct operations after the metal is rolled and cut to size. Gauge 26 
is used to prevent warpage or distortion of the backing. 

The profession will be glad to learn that the Columbus Dental 
Company have secured the co-operation of Dr. Leon Williams, who 
has already made a series of moulds for Steele posteriors on his 
*'trubyte" system, and it is expected that these will be on the market 
during the present year. 

An Electric Vulcanizer. 

The Buffalo Dental Manufacturing Company exhibited a Lewis 
vulcanizer with electrical heater and special control for both time and 
heat. This machine is made for any voltage and for either direct or 
alternating current. It possesses all the advantages of electricity 
over gas, and is cleaner and more steady in operation. Upon the 
desired heat being reached the current is cut off and turned on again 
ciutomatically as frequently as is necessary to maintain the prede- 
termined degree. 

One of the apparent advantages of the electric vulcanizer is that 
it cannot be heated up too rapidly, thus avoiding porosity in plate 
work. Depending upon the temperature of the water used, the vul- 
canizer reaches 320 degrees in from twenty-five to thirty-five minutes. 
Bubbling Cup Attachment For Cuspidor. 

Many new designs for fountain cuspidors were shown, and one of 
the newer features which have been well developed by the A. C. 
Clark Co. is that of the bubbling cup attachment. People are being 
educated to this sanitary method of drinking water, and it is pre- 
ferred by most patients to the use of the paper cup. Unless the 
ordinary drinking glass is cleaned, sterilized and polished for each 
individual patient, the bubbling cup is certainly much to be preferred 
in dental practice. 

Maintaining Dental Instruments in Proper Condition. 
A new service has been added to the organization of the Cleve- 



ORAL HEALTH 209 

land Dental Mfg. Co. to be known as the "Efficiency Department." 
This department issues an "Efficiency Service" contract, which per- 
mits the dentist to send burs of all kinds, root facers, reamers and 
other engine instruments of the Clev-Dent manufacture to the Cleve- 
land factory to be resharpened. The instruments are, of course, duty 
free, and are shipped in mailing cases supplied by the company. The 
charge of this service is $7.20 per year, or in other words, 60c per 
month, regardless of the number of instruments in use or frequency 
with which they are sent. Any bur with broken blade or that cannot 
be sharpened is returned to the dentist. Under this system, it is 
argued, more painless dentistry will be practised than would other- 
wise be possible, and the suggestion is made that those taking advan- 
tage of this service should not use a bur for more than one patient 
without sending it to the factory for resharpening. 

Special Engine Bur Steel. 

The Ransom & Randolph Company exhibited a complete range 
of engine burs made of special alloyed steel. It is claimed that the 
bur may thus be tempered to greater hardness than is possible with 
ordinary steel, and yet avoid undue brittleness. 

New Dental Furniture. 

A special prophylactic cabinet, shown by the American Cabinet 
Co., attracted a great deal of interest. The cabinet is smaller than 
an ordinary dental cabinet, and is light and portable. The upper 
section consists of six trays, twenty-six inches wide, with sufficient 
room for two complete sets of pyorrhea instruments. The lower part 
is arranged for strips, discs and other instruments used in prophylactic 
work. The object is to have all these instruments together and sep- 
arate from the regular cabinet. 

This company also exhibited a very ornate waste holder, which i.<; 
designed to supplant the "Just-Rite" pail. It stands uj)on the floor 
in the form of a mahogany pedestal, and contains a sanitary paper 
bag, which may be lifted out and thrown aside with the contents. 

Pyramid and Cone Impression Points. 
Kerr Compound was shown in boxes of both jiyramid and cone- 
shaped pieces for taking the impression of a cavity in inlay work by 
the indirect method. There was also shown a special "set-up" wax 
for attaching and holding the teeth during a try-in. Special wax for 
this purpose was also exhibited by the Caulk Company. 

New Root Clamps. 

Bicuspid and molar root clamps upon linos of new con.«;truction 

enabling them to catch and hold on almost any shaped tooth, was 

shown by the Ivory Company. Also special wisdom tooth clamp 

for use in cases where the tooth is almost covered with «um tissue. 



210 ORAL HEALTH 

All-metal hand port-polishers, which enable thorough sterilization, 
also a lock band plier for holding the end of polishing strips, were of 

interest. 

Synthetic Cabinet. 

The new synthetic cabinet of the Caulk Company was much in 
evidence. This cabinet contains a heavy slab, with agate spatula, 
four ivory instruments with celluloid strips, eight powders and liquids 
with varnish and cavity lining. 

The metal cocoa butter holder is most convenient and contains a 
stick of cocoa butter modified with wax. This appliance enables the 
use of cocoa butter without the operator taking it in his hand, which 
is particularly advantageous in hot weather. 

Cold Gold Inlay. 

The Williams Gold Refining Co. had, at their exhibit. Dr. J. G. 
Hollingsworth (the originator of the Hollingsworth system) demon- 
strating his method of constructing gold inlays. 

Under this system the cavity is prepared the same as for an inlay. 
A special wax impression is then taken and an investment made with 
special cement, which is reinforced by means of a metal cup. This 
model is then placed in machine, which enables the gold to be con- 
densed in the mould at high pressure. The pressure may be varied 
at will. 

After the investment hardens the wax impression is lifted out and 
serves as a guide for finishing the occlusal surface of the filling. 

The New Cabinet Switchboards. 

Throughout the entire exhibit there seemed to be a tendency to 
depart from the fixed wall switchboard and to move in the direction 
of a separate unit. The Ritter Company showed some very attrac- 
tive switchboards, mounted in a cabinet, and with a wall mount that 
concealed the cords. 

The Pelton & Crane Company have carried the idea a step fur- 
ther and have produced what they call the "Electricabinet," which 
is much smaller than the usual switchboard cabinet, and constructed 
in a way to make it portable and automatic. The rheostat is set at 
an average point, and by picking up the instrument the current is 
connected, and by merely dropping the instrument back to its place 
the current is cut off. The portable and automatic features of the 
"Electricabinet" are very attractive. 

One Disappointing Feature. 
There was one disappointing feature. Many well-known manu- 
facturers did not exhibit. Exhibits of this character should be made 
as comprehensive as possible so that the educational features may be 
enhanced and members of the profession may have opportunity of 
studying all branches of dental manufacturers' art. 




Dr. Jacob Wesley Greene 
Born January 18, 1839. 
Died February 27, 1916. 



An Appreciation of the Late Dr. Greene. 
Dr. William A. Giffen, Detroit. 



IN the passing of Dr. Jacob Wesley Greene, the dental profession 
has lost one of its most esteemed and best known members, who 
for more than fifty years gave his best efforts to tl:o pubhc. Dr. 
Greene originally located in dental practice in New Albany. Indiana, 
where he married Miss Ann Kli/a Pitt. October 23. 1863. In 1 86() 
he removed to Chillicothe, Missouri, whore he was one o{ [\\c leading 
dentists and citizens for many years. 

About eighteen years ago he. with his brother. Dr. P. 1 . Greene, 
improvised the Greene System of Special Test-Method Impression 



212 ORAL HEALTH 

Taking and Plate Work, which he taught throughout the United 
States and Canada. 

In addition to instructing a great many dentists in his private 
course, he spent considerable time lecturing to societies, until to-day 
his methods are recognized as being most practical. 

In 1910 he published and copyrighted Greene Brothers' Clinical 
Course in Dental Prothesis on "New and Advance Test Methods," 
which has had and is still having a wide circulation in this country 
and abroad. 

He was a man of great strength of character, a profound student; 
a man who was always ahead of his time in thought, but lived to 
see many of his ideas adopted. 

He was devoted to his family and never was known to spend an 
evening away from home, excepting on his lecturing tours. He left 
four children: Dr. Dora Greene-Wilson, Kansas City, Mo.; Mrs. 
C. R. Hughes, Kansas City, Mo.; and a daughter and son in the 
Far West. 

Dr. Greene, just previous to his death, was about to publish, in 
book form, a number of poems of which he was the author. "The 
Final Calculation" was his favorite, and we herewith publish it in 
part: 

The Final Calculation. 

In viewing our relation to men and things about us. 
We wonder how the world would get along without us. 
But men have ever wondered the same in times before us, 
And so will generations, when we are gone, ignore us. 
As men have come and acted in past unnumbered ages. 
Just so will they continue to write its coming pages. 
'Twere not the times forgotten, nor the future's hidden woeing 
That now should most concern us, but what it is we're doing. 
Are we in turn (now listen) from human-kind receiving 
More blessings than the sorrows and woes we are relieving? 
We're either thorough bankrupts — no disputing our relation. 
Or human benefactors in the final calculation. 



Oral Hygiene Report. 



Halifax School Board Committee. 



THE following report has been submitted to the school authori- 
ties of Halifax by a committee of the Board, appointed for the 
purpose of presenting data upon the question: 
To the Chairman and Members of the Halifax School Board: 

Your committee on dental and eye and ear work beg to submit 
the following: 



ORAL HEALTH 213 

1st. — That a dentist of good standing be employed by the Board 
for a year, to give one afternoon a week during the school term to 
the exclusive work of the Board. This work to be carried on in his 
own office, and that the dentist employed shall buy his own materials. 
For remuneration he shall receive $300.00 per annum. 

2nd.^ — It is recommended that the Board appoint the Educational 
Committee of the Nova Scotia Dental Society as an advisory board 
on dental matters, in pursuance of the method employed in many 
cities on this continent. The result of such an action being that the 
Board always has at hand expert advice on all dental matters gratis. 

3rd. — It is considered advisable by the committee, if at all pos- 
sible, to get a room in the new (Acadian) school, and equip it for a 
dental infirmary. The location will appeal to the Board for the 
reasons below stated at least: 

(a) This location is in the part of the city most in need of dental 
service. 

(b) Will be near the office, consequently the nurse and medical 
doctor will be available for assistance any time they are 
needed, as in anesthetic cases or minor operations. 

(c) Having such a room in one of our school buildings, we would 
be following what many other cities from experience have 
proved to be the best method of housing the school clinics. 

(d) Be under the eye of the Board. 

4th. — The way to finance this recommendation may be outlined as 
follows: Of the $1,000 appropriation that we have at our dis[)osal 
that $600 this year be given over to the dental work. $300, as 
stated above, to go to the appointed dentist for his services, and the 
other $300 to put in as much first-class equipment as it will bu\ . 
Then at the beginning of the next financial year finish equipping the 
room, and install the operator in his new quarters. I his equipment 
would cost between $500 and $600. 

5th. — Both the Educational Committee of the Nova Scotia Dental 
Society and your own committee cannot imj^ress upon the Board too 
strongly the advisability when furnishing this room of using the vory 
best and latest equipment available. 

6th. — You instructed your committee to further report on the eye. 
ear and throat work in the schools. In reference to thi.s, the com- 
mittee feel that a separate and detailed report on it \vould cover the 
matter more to the general satisfaction of all. Such rei^ort we shall 
present very shortly. 

Respectfully submitted. 

(Signed) K. H. W'oonnL'RV. 

Halifax, N.S., March 30, 1916. Chairman. 



The Ontario Temperance Act As It Affects Dentists. 



THE executive of the Toronto Dental Society is to be congratu- 
lated upon its action in bringing to the attention of the Ontario 
Government the requirements of the dental profession under the 
Ontario Temperance Act. 

The suggestions contained in the following letter evidently com- 
mended themselves to the Government, the regulations being finally 
adopted in the form suggested: 

Copy of Letter From Executive Toronto Dental Society 
TO THE Hon. the Provincial Secretary. 

Toronto, April 5th, 1916. 
Hon. W. J. Hanna, 

Parliament Bldgs. 

Dear Sir, — Whereas an Act entitled "The Ontario Temperance 
Act" is being considered by the Legislature of Ontario, and whereas 
Section 38 of said Act provides for the sale by a licensee and a duly 
qualified member of the Royal College of Dental Surgeons of On- 
tario of one pint of liquor for use in his profession, we, the executive 
of the Toronto Dental Society, hereby request that a slight change be 
made in the Act to allow a duly qualified member of the Royal 
College of Dental Surgeons of Ontario to purchase, at one time per- 
sonally, a quantity not exceeding six ounces. 

And whereas Sec. 60, Sub-sec. 2, provides that a dentist who is a 
duly qualified member of the Royal College of Dental Surgeons of 
Ontario may keep in his office a quantity not exceeding one pint at 
any one time, we would also hereby request that this amount be 
1 educed to a quantity not exceeding six ounces. 

The above requests are made with the knowledge of the limited 
use of liquor as a stimulant or restorative, and we deem a quantity 
not exceeding six ounces quite sufficient for all dental purposes. 

Furthermore, we consider that a quantity so much greater than is 
necessary would tend to encourage the abuse of the privilege and use 
of liquor which is not intended in the Act. 

Trusting that these requests will meet with your approval, and that 
you will lend your assistance to our endeavors to safeguard the best 
interests of the public in general and of the dental profession in par- 
ticular, we are, 

Yours very truly, 
R. D. Thornton, E. F. Arnold, 

Secretary, 312 Roncesvalles Ave. President, 2 Bloor St. E. 



Important Legal Decision in Manitoba Courts. 



THE following judgment has been handed down by His Honor 
Judge Paterson of the County Court of Winnipeg, in which the 
taking of an impression of the mouth, or the fitting of appliances 
m the mouth, are held to be included in "the practise of dentistry." 
A similar decision was rendered by the Toronto Police Court Magis- 
trate some years ago. These cases would seem to put the question 
beyond dispute. The judgment is of such importance that we pub- 
lish it in full: 

Judgment — Bowles vs. The King. 

In this case action was taken under Section 31 of Ihe Dental 
Association Act, being Chap. 53 of the R.S.M. 1913. The infor- 
mation was laid against the accused on a charge of practising den- 
tistry for gain, not being a registered dentist. Action was taken in 
the Winnipeg Police Court and the case was heard before Sir Hugh 
John Macdonald, magistrate, and dismissed. The informant, who 
IS an officer of the Dental Association, appeals against the decision. 
All importance attaches to what constitutes practising dentistry, and 
whether making a plate for the mouth with one or more teeth attached 
comes within that category. In Henram & Co., Limited, vs. Duck- 
worth, 20 T.L.R., 436, it was held that making a plate was not 
practising dentistry, and were it not for such like authority I would 
be strongly inclined to think it is part of the work of the [)ractising 
dentist. It does seem to me that any work properly performed by a 
person claiming to be a dentist and performed m or for the mouth of 
a patient pertaining to the teeth, or furnishing what is commonly 
called artificial or false teeth, would constitute dentistry, and if done 
successfully would constitute the practise of dentistry. Henram vs. 
Duckworth is authority also for holding that taking an impression 
and fitting in a plate is practising dentistry. Objection was taken by 
counsel for the accused as to the regularity of the proceedings in 
bringing on this appeal which I have, after some consideration, over- 
ruled, as they were more or less technical. 

The facts as I find them from the evidence arc that accused was 
employed in the dental parlors of Dr. Glasgow in the city of Winni- 
peg; that on the 16th of June one C. A. Benjamin called at the 
parlors and was asked to return, which he did on the I 7th. when the 
accused examined his mouth, took an impression of his gums, and 
later on in the day fitted a plate in his mouth. On the 21st of Juno 
he did some work for one Fetterly by grinding one of his teeth with 
some kind of instrument. The accused, and Dr. Glasgow for him. 
both endeavored to minimize this evidence, but 1 do not think the 
witness Fetterly was not stating a fact as to the work on the teeth 
even if he could not just locate the room in which it was done or the 



216 ORAL HEALTH 

exact kind of instrument the accused used. I believe accused did do 
some work, properly the work of a dentist, on Fetterly on that date. 

I should think the evidence would not require to be very severely 
sifted when, as in a case such as this, the accused was employed in 
a somewhat extensive dentistry office and where he was known as 
Dr. Austin, where he did a considerable amount of work. I think 
there might be a very strong presumption that the accused was prac- 
tising the profession of dentistry. 

Was he practising for hire, gain or hope of reward? From the 
evidence of himself and Dr. Glasgow it might readily be concluded 
he was not working merely to mark time until the fall when things 
would be better. He was receiving $42.00 per week until the time 
of the laying of the information before the magistrate; these weekly 
payments were suddenly stopped if the witnesses are to be believed, 
but there was no stopping of work on the part of the accused. He 
went on as usual doing, as he said, work for others, and using the 
material and tools of Dr. Glasgow. If he got nothing else than the 
material, quite a lot of which he said he used, or if he got nothing 
but that and the privilege of doing his own work in Dr. Glasgow's 
premises, he was not working without gain, and the statement that 
he was to work until fall, when times would be better, would be some 
hope of reward. In short, I do not credit the statement that the 
accused was not working for gain to Dr. Glasgow, for nothing for 
himself, but on the contrary I believe he was working for gain. I 
look upon the transaction when he directed Fetterly to pay the cashier 
tor work done by himself as a mere subterfuge. The money paid 
was for services performed by accused and landed in Dr. Glasgow's 
hands to pay for a room in which accused occupied working quarters, 
for tools which accused was performing dental operations with, and 
for material that accused used on his own behalf. 

I find that accused did take an impression of the gums and later 
fitted a plate in the mouth of Benjamin, and that on the 21st he did 
some work for Fetterly, and that the accused was on the 1 6th, 1 7th 
and 21st days of June practising dentistry for gain and without being 
legistered under the Dental Association Act. I allow the appeal and 
fix the fine at $50. 

(Signed) Geo. Paterson, 

January 6, 1916. Judge, Winnipeg County Court. 



□II I D 

' THE COMPENDIUM 

This Department is Edited by 
THOMAS COWLING, D.D.S., Toronto 

A SYNOPSIS OF CURRENT LITERATURF. FUJ.XTINC 
TO THE SCIENCE AND PRACTICE OF DFNTISTHV 



SucciNiMiD OF Mercury. 

SO numerous and so ineffective have been the remedies offered for 
the treatment of pyorrhea alveolaris, that the addition of one or 
more to the Hst creates, possibly, Httle interest. If, however, it 
can be show^n by cHnical evidence that a particular method of treat- 
ment will bring about a very high percentage of cures, then the 
attention of the profession is bound to be focussed upon the new 
arrival. 

The use of succinimid of mercury as a means of combatting 
pyorrhea is being advocated by some of the leaders of American 
dentistry. In the opinion of Dr. Kusel (Cosmos), the only proper 
method of administration is the intra muscular injection. Subcu- 
taneous injection produces most distressing results: irritation of the 
part occurs, leaving a painful area which may remain unhealed for 
some considerable time. 

The technique of mercurial injection is described by Dr. C. S. 
Copelan (Cosmos), and is based on his observation of the method 
followed by the originator of the treatment Dr. Wright, of Ports- 
mouth Naval Yard, U.S.A.: "The syringe used is made by Bur- 
roughs, Wellcome & Co., all glass and holding forty minims. I he 
needles used are No. 26 intra muscular for the above syringe. I he 
solutions are so made that gr. 1-5 of mercuric succinimid is dissolved 
in four minims of hot, sterile distilled water. I'ho site of injection is 
the buttock, using alternate sides for succeeding injection.^;. 1 ho skin 
i? sterilized with tincture of iodine. The method of inserting the 
needle is as follows: The needle butt is hold between the thumb and 
finger, with the index finger over the butt. The shaft of tho noodle 
to be perpendicular to the skin surface, tho point about throo inches 
from it. With a quick, forceful, downward thrust, tho noodle is 
driven deeply into the substance of the gluteal muscle, from point to 
butt. Then into the syringe as many minims of the sterile mercury 
solution as represent the desired dose are drawn: if it is to bo gr. v ). 



218 ORAL HEALTH 

minims XX will be required. Then the syringe tip is inserted into 
the socket of the needle and the injection is made slowly. The needle 
is withdrawn and tincture of iodine is applied to the point of injec- 
tion. The injections are to be repeated every seventh day." 

The amount of favorable evidence submitted by numerous prac- 
titioners testifies to the efficacy of this remedy. No one can question 
the sufficiency of the dentist's skill in administering this or any other 
drug, yet in view of the area to be operated upon it would almost 
seem advisable that it be left to the physician. The administration 
of any remedy by methods simulating that described above might, in 
the opinion of the public, be outside the proper sphere of dentistry. 
If any unfortunate results occurred it might be a difficult matter for 
the dentist to assuage public sentiment. 

Nickel-Copper Amalgam. 
The value of copper-amalgam in dental operations has long been 
recognized. The ease with which it may be manipulated, its hard- 
ness, its preservative qualities, place it well up in the list of good 
fillings materials. Its disadvantages, both of color and solubility 
(cupping), limit its use however. 

Dr. Sims Lever (Commonwealth Dental Review) describes a 
nickel-copper amalgam which, in his opinion, "has all the virtues of 
copper-amalgam without any of its disadvantages." It is claimed 
for this nickel-copper-amalgam that it stands the stress of mastication 
perfectly, keeps a good color, does not stain the tooth substance, does 
not expand or contract, and gives no indication of cupping — a char- 
acteristic of copper-amalgam due to the solubility of its parts. 

Dr. Lever finds that this amalgam answers most satisfactorily in 
those almost inaccessible positions where it is absolutely impossible to 
obtain or maintain a dry cavity. It is eminently suitable for chil- 
dren's teeth, both temporary and permanent. 

Gold in Dental Amalgams. 
Many of our leading authorities on amalgams question the advisa- 
bility of incorporating gold in dental amalgam alloys. Others claim 
that a small percentage of gold imparts a pleasing whiteness to the 
alloy. To this last group belongs Dr. W. Bruce Hepburn. His 
alloy consists of gold, silver, copper and tin in the following propor- 
tions : 

Gold 4.4 per cent. 

Silver 52.0 per cent. 

Tin 40.6 per cent. 

Copper 3.0 per cent. 

Dr. Hepburn describes his method of preparation as follows: "I 
melt the gold in a new crucible, which has been annealed and glazed 
with borax. The silver and only half the copper is stirred in, using 
a carbon rod for the purpose, then the balance of copper, meanwhile 
the heat being gradually lessened, only sufficient being applied to 



ORAL HEALTH 219 

keep the metals liquid and not blazing hot. On the last of the copper 
being dissolved, carbon chips are dropped in, the heat is cut off, and 
the tin wrapped in tissue paper dropped in in small quantities and 
well stirred. The addition of tin causes the lowering of the melting 
point of the alloy, hence the cutting off of the heat. The alloy is 
poured into a well-oiled ingot and immediately immersed in cold 
water." 

The subsequent treatment refers to the filing of the alloy. The 
6-inch bastard file is used for this purpose. Any particles of steel are 
removed from the filings by means of a magnet. In order to age the 
alloy it is bottled up and placed in boiling water for fifteen minutes. 

Dr. Hepburn concludes his excellent paper by a warning against 
the use of zinc in dental amalgam alloys. He finds that zinc "seems 
to exhibit the peculiar effect of acting, even in conjunction with silver, 
tin and copper as a separate metal, and wasting and washing out." 

Paraform. 

This preparation is described by Dr. C. Evory Brown (British 
Dental Journal) as conforming very nearly to the ideal obtundent. 
It is a white powder, powerfully antiseptic, and with a pungent odor. 
Paraform is simply solidified formaldehyde gas. Being very irritant, 
it must not be placed near the dental pulp. 

In applying paraform to a cavity it is best to mix the required por- 
tion with temporary cement, incorporating the paraform with the 
cement. The mixture is allowed to remain in the cavity for about 
three days. Owing to its extremely irntatng qualities, paraform 
ought to be kept away from those cavities where caries has penetrated 
well into the tooth substance, and its use ought to be confined to 
superficial cavities — those being at all times the most sensitive. 

"The effect of paraform upon dentine tissue varies in proportion to 
the hardness of the tissue to which it is applied. In small cavities, 
which have only just penetrated the enamel, it acts slowly and with 
difficulty. On the hard polished surfaces of erosion cavities it also 
finds great difficulty in penetrating, but in cases where the dentine is 
soft enough to be removed with an excavator, a ten i)er cent, dressing 
will quickly penetrate an appreciable distance, and render the ca\ity 
quite insensible up to the limit of its penetration." 

In the cavities approaching the pulj), paramono-chlorophenol is 
recommended as a useful drug, being a powerful anodyne and anti- 
septic. "A powder composed of zinc oxide, with ten per cent, of 
thymol mixed to a stiff paste with a liquid consisting of ecjual parts of 
paramono-chlorophenol and eugenol, is extremely soothing. I his 
liquid, if used to moisten arsenical fibre when devitalizing nerves, 
greatly helps to control the pain." 

Root Canal Treatment and Filling. 

During the past few months the especial attention of the dental 
profession has been directed to the importance of correct methods in 



220 ORAL HEALTH 

the treating and filling of root canals. At a recent convention, held 
in Chicago, a large percentage of the clinics given dealt with this 
phase of dental operations. 

In view of the amount of attention which is being given to this sub- 
ject, we read with great interest and profit a paper by Dr. Geo. C. 
Poundstone, Chicago, published in April issue of Dental Revien}, 
"Root Canal Treatment and Filling." In this paper he outlines in 
detail his method of operation. 

In the opinion of the author, it is impossible to prepare a vital tooth 
for a crown without endangering the life of the pulp and causing the 
patient pain. He therefore urges the necessity for removing the pulps 
of teeth to be so treated, and providing an efficient filling to replace 
the lost tissue. 

It is suggested that, when pulps having dead coronal and vital 
apical portions are to be removed, a treatment of beechwood creosote 
be sealed in the cavity for three or four days, after which time the 
remaining pulp may be removed with little pain to the patient. Dr. 
Poundstone does not favor the practice of sealing in arsenic against 
the vital apical portions of the pulp on account of the close proximity 
to the apical foramina. There is always a danger of the drug passing 
through the openings and setting up inflammation in the process. 

When treating gangrenous pulps, extreme care is necessary in order 
to avoid the forcing of any of the contents through the apical foramen. 
In the author's opinion, formo cresol is an excellent preparation for 
use in such cases, yet it must be cautiously handled in order to prevent 
the condition of soreness so evident in teeth that have been subjected 
to the influence of this drug. "Formo cresol must have putrescent 
material to work upon, that the formaldehyde gas may be neutralized. 
Therefore, if there be no putrescent material present to neutralize the 
expanding formaldehyde gas, it will pass through the apical foramen 
and irritate the peri-apical tissues, causing soreness and tenderness." 

Enlarging the Canals. — When enlarging root canals. Dr. Pound- 
stone places great dependence upon the use of barbed broaches. The 
fine barbed broach is inserted in the canal to be enlarged, and with- 
drawn several times. "By withdrawing the broach, inclining it in 
turn towards all sides of the canal several times, the smallest canal 
will be enlarged sufficiently for treatment and the reception of a good 
filling." A word of caution is given against the practice of rotating 
barbed broaches in small root canals. The preferable course sug- 
gested is the insertion and withdrawal of the broach with a lateral 
pressure in order to file away the sides of the canal. The use of acids 
as a means of enlarging canals is not deemed advisable, owing to the 
uncertainty as to the extent and direction of its action. 

Sterilization of Canals. — After the pulp has been removed and the 
root canals have been enlarged, an antiseptic dressing is sealed in for 
a few days. 



ORAL HEALTH 221 

Cleansing the Hands.- — On the bracket-table is placed a small jar 
of antiseptic solution (cyanide of mercury). In order to cleanse the 
fingers after touching anything that might be unclean, the operator 
dips a piece of cotton in the solution and squeezes it between the 
fingers. A clean napkin is used to wipe away the liquid from the 
hands. In this way there is little danger of contaminating the cotton, 
etc., used in dressing root canals. 

Cutta-Percha Cones. — All cones are sterilized by placing them in 
95 per cent, alcohol for ten minutes. After drying in aseptic gauze, 
they are placed away in large sterile gelatine capsules. 

Cotton. — The cotton is purchased in cartons and is accepted as 
being aseptic. It is put away in tightly covered containers and so 
protected from the air. 

Rubber Dam. — The placing of the rubber dam about the tooth to 
be treated is deemed absolutely necessary if asepsis is to be estab- 
lished. Before adjusting the dam both tooth and gums are subjected 
to suitable treatment to remove all foreign substances. 

Dry^ing Canals.- — When the canals are opened up, all traces of 
cotton, etc., are carefully removed and the canals are bathed with 
60 per cent, alcohol, applied on cotton with a smooth broach. This 
is absorbed by dry cotton and the application of warm air. If hot 
air be applied too freely there is a likelihood of causing injury to the 
tooth structure by over-dehydration. Only the surface moisture 
should be removed, hence 60 per cent, alcohol is used. 

Lubricating Canals. — The canals receive an application of euca- 
lyptol. This lubricates the canals preparatory to the insertion of the 
filling material. 

Filling Canals. — A section of gutta-percha cone, not more than 3 
millimeters long and of a size corresponding to that of the canal, is 
attached to a heated plugger and allowed to cool. It is then dipped 
in eucalyptol and carried into the canal and forced as far as it will 
go. The plugger is then removed, warmed and again passed into 
the canal and more condensation of the gutta-percha secured. Other 
pieces of cones are attached to the plugger and carried into the canal 
and condensed until the canal is completely filled. Any excess in the 
pulp chamber is then removed with a heated ball burnisher, which 
at the same time seals over the mouth of the canal. 



Eastern Ontario Dental Convention. 



T 



HE Eastern Ontario Dental Association will hold its annual 
meeting at Stanley Island, June 21st, 22nd and 23rd. 1910. 

L. E. Stanlp:y, Secretary. 




Coniplimenlary copies of 
Oral Health will be sent 
(luring the progress of the 
war to all Dental (Jraduates 
on active service whose 
army address is known. 



:m^miuimL^M.MMMMMMm iMmmMimmii, mMAmMim 



HONOR liOI.I. 

Major C. E. Sale. 18th Batt., 4th Brigade. 



Lieut. 
Lieut. 



CANADIAN ARMY DENTAL CORPS 
Overseas* 

Capt. A. W. Winnett. 
Capt. J. E. Wrig-ht. 
Lieut. H. F. Alford. 
Lieut. G. Atkinson. 
Lieut. R. H. Atkey. 
Lieut. W. A. Burns. 
Lieut. G. H. Bray. 
Lieut. H. Clarke. 
Lieut. A. R. Currie. 
Lieut. G. H. Fowler 
Lieut. A. A. Garfat. 
Lieut. W. H. Gilroy. 
Lieut. D. H. Hammell. 
Lieut. J. W. Hagey. 
Lieut. H. C. Hodgson. 
Lieut. E. W. Honsinger. 
Lieut. E. C. Hutchison. 
Lieut. R. Jamieson. 
Lieut. J. L. Kappele. 
Lieut. E. J. Kelly. 
Lieut. O. Leslie. 
Lieut. A. G. Lough. 
Lieut. C. A. McBride. 
Lieut. W. G. MacNevin. 
Lieut. C. E. McLaughlin. 
Lieut. R. McMeekin. 

Concentration Camps 

Lieut. T. W. Caldwell. 
Lieut. C. E. Campbell. 
Lieut. E. H. Campbell. 
Lieut. A. V. Cashman. 
Lieut. E. H. Crawford. 
Lieut. Karl Damon. 
Lieut. J. M. Deans. 
Lieut. R. L. Dudley. 
Lieut. J. H. Duff. 
Lieut. J. N. Dunning. 
Lieut. W. R. Eajnan. 
Lieut. R. ^V. Fell. 
Lieut. H. B. Findley. 
Lieut. R. W. Frank. 
Lieut. J. P. Gallag-her. 
Lieiut. B. R. Gardiner-. 

tActing Director of Dental Services, address Ottawa. ^Lieutenants rank as 
Captains while overseas. C.A.D.C. overseas address — 'Care Director Dental 
Services, Canadian Contingents, 2.3 Earls Ave.. Folkestone. England. 



Lt.-Col. J. A. Armstrong. 
Major O. K. Gibson. 
Major A. A. Smith. 
Capt. J. W. Bell. 
Capt. C. Brown. 
Capt. J. F. Blair. 
Capt. G. N. Briggs. 
Capt. W. J. Bentley. 
Capt. G. S. Cameron. 
Capt. O. A. Elliott. 
Capt. E. A. Grant. 
Capt. W. R. Greene. 
Capt. George Gow. 
Capt. O. G. Hassard. 
Capt. J. E. Holmes. 
Capt. G. G. Hume. 
Capt. F. W. B. Kelly. 
Capt. H. Lionais. 
Capt. F. R. Mallory. 
Capt. A. E. Mullin. 
Capt. B. L. Neiley. 
Capt. E. B. Sparkes. 
Capt. G. H. A. Stevenson. 
Capt. L. N. Trudeau. 
Capt. C. F. Walt. 
tMajor W. B. Clayton. 

Capt. G. C. Bonnycastle 
Capt. F. H. Bradley. 
Capt. C. D. DesBrisay. 
Capt. D. M. Foster. 
Capt. W. T. Hackett. 
Capt. W. Y. Hayden. 
Capt. Jas. M. Magee. 
Capt. H. L. Mitchener. 
Capt. J. G. Roberts. 
Capt. S. H. Simpson. 
Lieut. J. T. Adams. 
Lieut. S. G. Alderson. 
Lieut. N. S. Bailey. 
Lieut. D. J. Bag.shaw. 
Lieut. J. A. Beatty. 
Lieut. F. C. Briggs. 



Lieut. B. P. McNally. 
Lieut. E. McNeill. 
Lieut. H. C. Macdonald. 
Lieut. J. W. Macdonald. 
Lieut. E. D. Madden. 
Lieut. V. C. W. Marshall. 
Lieut. L. L. Matchett. 
Lieut. G. V. Morton. 
Lieut. J. F. Morrison. 
Lieut. J. B. Morison. 

C. H. Moore. 

P. E. Picotte. 
Lieut. H. Ross. 
Lieut. J. Roy. 
Lieut. W. A. Sangster. 
Lieut. J. F. Shute. 
Lieut. D. P. Stratton. 
Lieut. R. C. H. Staples. 
Lieut. E. S. Tait. 
Lieut. L. A. Thornton. 
Lieut. H. P. Thompson. 
Lieut. H. P. Travers. 
Lieut. D. D. Wilson. 
Lieut. Karl F. Woodbury. 
Sg^t. R. J. Godfrey. 
Sgt. E. F. Jaimieson. 

Lieut. G. E. Gilfillan. 
Lieut. J. S. Girvin. 
Lieut H. J. Henderson. 
Lieut. P. J. Healey. 
Lieut. F. Hinds. 
Lieut. H. A. Hoiskin. 
Lieut. R. O. Howie. 
Lieut. G.H.Hollingshead. 
Lieut. H. C. Jeffrey. 
Lieut. C. M. Joyce. 
Lieut. Frank Knight. 
Lieut. L. Lemire. 
Lieut. T. H. Levey. 
Lieut. C. C. Maclachlan. 
Tjieut. H. C. Mann. 
Lieiut. W. Mia.^-om. 




Concentration Camps. — (Continued.) 



Lieut. D. 
JLieut. W. 
Lieut. E. 
Lieut. D. 
Lieut. "\V. 
Lieut. W. 
Lieut. L. 
Lieut. G. 



W. 

J. 
F. 
K. 

S. 
H. 
D. 
A. 



Massey. 

.McEwen. 
McGregoi- 

Mcintosh 

McLaren 

ilcLaren. 

McLaurin 

Munx'oe. 



Lieut. A\ 

Lieut. J. 

Lieut 

Lieut 

Lieut 

Lieut 



'. H. 
\V. 
T. E. 
J. A. 
W. J. 
H. A. 



Lieut. .1. A. 



Lieut. Otto Na.se. 
Lieut. H. A. Nesbitt. 
Lieut. J. G. O'Neil. 
Lieut. R. M. Peacock 
Lieut. F. H. Quinn. 



Heid. 
Reynold.s. 
E. Robins. 
Ro.ss. 

Rutherford 
Simmons. 
Stewart. 
. Svvitzer. 
Thomas. 
Thompson. 
Wark. 
Washburn. 
Wesrott. 



Lieut. G 
Lieut. C. 
Li»'Ut. F 
Lieut. E. 
Lieut. J. 

Lieut, f:. 

Lieut. J. 
Sgt. E. G 



A. 
E. 

M. 
H. 
H. 

R. 
H. 



Sut. 

Sst. 

s-t. 
Sg:t. 
S,q:t. 



H. 

H. 

G. 

J. 

W. 



R. 

r. 

R. 

u. 

.1. 



Capt. 
Capt. 
Capt. 
Capt. 



T. 
A. 
H. 
F. 



Lieut. W. C 
Lieut. A. J. 
Lieut. E. L. 
Lieut. .\. E. 
Lieut. B. L. 
Lieut. V. D. 

C. Bruce. Divisional Officers 

Dubord. Capt. W. G. Trelford. Capt. F. M. 

T. Minogue. Capt. (ieo. K. Thomson. Capt. J. M. 

P. Shaw. Capt. W. G. Thompson. Capt. \V. ^V 

ATTACHED TO CORPS OTHER THAN C.A.D.C. 
Overseas 



Wilcox. 

Williams. 

Williamson. 

Wil.-^n. 

Wiltze. 

Zimmerman. 

Zlnn. 
Berry. 
Conway. 
Goodhand. 
McMill-in. 
Reid. 
Taylor. 



Wells. 
Wilson. 
. Wripht. 



. Ballachev, 58tli Hatt. 
Cameron, f)th C.M.R. 
Coghlan. 25th Battery. 
A. Corrigan, Army Ser 



Batt. 



Capt. 
Capt. 
Capt. 
Lieut. 
Lieut. 
Staff 



Major P. I 
Major G. S. 
Major F. T. 
Major Chas. 
vice Corps. 
Capt. K. C. Campbell, 43rd 
Capt. J. R. Duff, 79th Batt. 
Capt. J. Harper, Royal Navy. 

Concentrat 

Lieut. Col. E. F. Armstrong', 159th 

Batt. 
Lieut. -r-ol. Neil Smith. ISOth Batt. 
Major H. A. Croll, 10th C.M.R. 

UNDERGRADUATES 

Overseas 



J. L. McLean, aiuh Batt. 

Walter McNally. 179th Batt. 

S. J. Redpath, 47th Ritt. 

A. R. Leggro. 58th Batt. 

H. J. :\rcLaurin. J.ird Batt. 
Sgt. J. G. Roberts. C.A.M.C. 



Pte. S. P. Marlatt, Prinr.-s.< Pats. 

on Camps 
Major .\. Schnarr, '.Mth liatt. 
Capt. A. L. Johnson, fiSth Batt. 
Lieut. C. Nicholson. 12:Uh Batt. 
Lieut. C. E. Wright. SOth Batt. 



F. ir. Barry, C.A.D.C. 
A. Chambers, C.A.D.C. 
E. R. Dixon, 71st Batt. 
J. E. Dores, C.A.D.C. 
E. Garfat, 71st Batt. 
J. E. Irwin, C.A.D.C. 
J. T. It \vin» 4th I^ofT.Co. 



Lieut. R. M. Barbour 

W. G. .\ 1st on. 67 th Ba.ttory. 

H. R. .\nderson. (>7th Battery. 

II. G. Bean. 198th Batt. 

R. Bishop. C..\.D.C. 

R. T. Broadworth. (i7th Battery 

.\. G. Calbeck. fi7tih Battery. 

.\. E. Chegwin. 19Sth Batt. 

F. Cluff. Ifilst Batt. 

(). G. IXjiiIn-vniple. <i7th Ba^ttcry. 
E. N. Elliott. C..\.D '\ 
R. W. Free.'^trne. fi7th llalttry. 
IT. Greenwood. 7tUh Batt. 

G. E. H'ltne- <\F U 

G. M. TTeisz. Div. Siir. Corps. 
A. S. Holmes, Div. Sig. Corps. 
G. W. Tlowson. 12r)th Batt. 
T. H Hntchins.Mi C. A.IVC. 
.T T. i."vvin. 4th \\ Co. 
G. G. .Tewitt. Field .\mb. 



.\. W. Jones. C.A.D.(\ 
J. V. Lally. C.A.D.C. 
J. G. Larmour. C.F..\. 
H. B. Legatf. C..\.D.(\ 
W. C. Legett. C..\.D.C. 
E. S. MrBride. C.V.D.cr 
C. V\ McC.iitn«"y. C,.\.D.r 

Concentration Camps 

fi4th B«tt 



R. B. M<«luire 
Corps). 



(British 



R. 
T. 
.\. 
B. 
R. 



E 



:M<L:iui;hlin.C.A.D.C 
Walker. C.F.A. 



Walton. < 
Watson. ( 
H. Winir. 



.\.M.C. 

.\.M.r. 
\ A.D.r. 



.\. N. Lriidlaw. Mach. "'lUn. 
E. C. McKee. C.V.D.C. 

\'(Le«>(l. niv. Siir. Corps. 
M:i«k,iv. <;7th Bnttory. 
M<»yi.'. K7th Il.'itt«'r>'. 
Murray. .Vrmv Trnn.««port. 

N(»rt()"n. (\.\.1><". 
Parker. C.A.D.C. 

Poag. C..\.D.<^. 

Porter. C. .\.M.C 
Ram.'ige. C.V.M.C. 

'Neid, Me<'hanical T»:m-p. 

.<;h«Mt i<lan. rt7lh Batt<My 
Sirrs, .\rmy Tr.in-^porf . 
Sl«vin. :50th Batt 

Smith. IfiOth Batt 

Smith. Div. SIg. Corpi*. 
.<;i>iir. »;7th IVUtory. 
Steoh>. «57th Bittery. 
Thomp'^^n. C N.n.O. 



.1. 


M. 


w 


111. 


( ' 


T 


G. 


s. 


.\ 


L. 


C. 


T. 


.\. 


R. 


^^' 


. .\. 


c. 


C. 


IT 


il. 


w 


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«i. 


\. 


G 


H. 


\V 


H. 


w 


L 


V. 


H. 


c. 


W. 


F 


L. 



D 



MULTIM IN PAEVO 

This Department is Edited by 
C. A. KENNEDY, D.D.S., 2 College Street, Toronto 

HFLPFUL PRACTICAL SUGGESTIONS FOR PUBLICATION. SENT IN BY MEM- 
BERS OF THE PROFESSION, WILL BE APPRECIATED BY THIS DEPARTMENT 



D 



D 



Securing High Polish in Vulcanite Plates. — To put a 
high poHsh on plates, the chalk is mixed with ammonia water instead 
of pure water and washed off with tepid water. — Pacific Dental 
Gazette (Dental Cosmos). 

Extracting Upper Teeth and Lower TttTH at the Same 
Sitting. — Where it is necessary to extract teeth or roots from the 
superior maxilla and the inferior maxilla it is always best to operate 
in the inferior maxillary region first. By so doing the field of opera- 
tion will not become obscured, whereas if you operated in the superior 
maxilla first the inferior maxilla and the floor of the mouth would be 
entirely filled with blood and render the operation complicated and 
difficult. — Walter C. McCauley, Boston, Mass. (Dental Review). 

To Facilitate Cementing a Gold or Porcelain Inlay. — 
Mounting the inlay, in its proper position, to enter the cavity in the 
right direction, on a tapered orange-wood stick will greatly expedite 
matters when it means much to both operation and patient. It avoids 
all possibility of confusion that so often arises when using tweezers or 
fingers to place inlay in cavity while both of the latter have been 
smeared with cement, thus causing more deception as to position. — 
W. D. N. Moore, Chicago (Dental Review). 

Repairing Plaster Casts.— Celluloid is dissolved in equal parts 
of camphor and ether, enough to make a creamy mixture. The parts 
of the cast are prefectly dried, painted with this solution, firmly united, 
and allowed to dry. This celluloid mixture is insoluble in water, and 
does not suffer by vulcanization. — La Odontologia Peruana (Dental 
Cosmos). > 

A Dressing For Impressions Before Pouring With Plas- 
ter of Paris. — Dissolve base plate rubber in chloroform; apply by 
coating impression. Warm before separating by tapping it, only 
when a full upper. — (Dental Summar"^). 

Waterproofing Plaster Models.^ — To make plaster models 
which can be washed, the following procedure is used: First, the 
model is hardened by applying a solution of borax and alum. Then 
some insoluble precipitate is used which will fill up the pores and pro- 
duce a very hard surface. The salts of barium, calcium, or strontium 
are suitable, and will not stain the model. — Revistas Dental de Perie 
(Dental Cosmos). 



ORAL HEALTH 225 

To Prevent Engine Cord From Slipping. — A little beeswax 
and resin applied to the engine cord will prevent it from slipping. — 
Pacific Dental Gazette (Dental Cosmos). 

Securing Brightness in Aluminum Rubber Plates.— The 
hydrogen sulfid liberated in vulcanizing has a tendency to darken the 
aluminum in aluminum rubber plates. To avoid this, the aluminum 
base plate is covered with shellac or sandarac. — Zahnaerztliche 
Rundschau (Dental Cosmos). 

To Keep Synthetic Slab Polished and Free From Grease. 
— Take wet powdered pumice on tips of fingers. Polish slab all 
over; rinse in running water and slab is like new again; this will not 
scratch. — E. P. Hanrahan, D.D.S., Chicago, III. (Dental Digest). 

Emergency Repair of Rubber Bulb of Chip Blower.— 
The break in the rubber bulb of a chip blower may be covered with 
a piece of adhesive tape. This makes it as useful as ever. — /. A. 
Tibboth, D.D.S., Wilkinsburg, Pa. (Dental Digest). 

Cleaning the Cervices of Teeth Before Applying the 
Rubber Dam. — The rubber dam should never be applied to a tooth 
before its cervix has been cleaned and disinfected. If this precaution 
is omitted, infectious material is forced by the rubber and the liga- 
tures under the gum margin, where it may remain for hours. The inter- 
ruption in the circulation of the blood favors infection of the weak- 
ened tissue. For disinfection, hydrogen dioxide, followed by thymol- 
alcohol, is recommended. — H. Pichler (The Dental Cosmos). 

Cement For Mending Plaster Casts. — The following makes 
a reliable cement for mending broken plaster casts: Dissolve cellu- 
loid in acetone to a syrup consistency. Smear the fractured surfaces 
and press together for a minute or two. It dries quickly and holds 
securely. — Pacific Dental Gazette. 

The Use of Floss Silk in the Dental I^oilet. In the use 
of the floss silk, one should first rub tooth-powder into the dental 
interspaces and then pass the floss gently down to and under the gum 
margin of one tooth without forcing into it so as to prduce mechanical 
injury. The floss should then be bent as nearly as possible half-way 
around that particular tooth, and then with a slight sawing motion 
be slowly wiped over the entire approximal surface and part of the 
buccal and lingual as the floss is drawn toward the occlusal and out 
between the teeth. Next the floss is passed into the same space, and 
the adjoining tooth cleansed. The performance of the act once a 
week should be supplemented by the use of a thin rubber band 
nightly, as it is soft and less injurious mechanically than the floss. 
(Dental Record). 




ORAL HEALTH 



B 



EDITOR 

WALLACE SECCOMBE. D.D.S., Toronto, Ont. 

CONTRIBUTING EDITORS 

GEORGE K. THOMSON, D.D.S., Halifax, N.S. 
F. W. BARBOUR. D.D.S., Fredericton, N.B. 
ASHLEY W. LINDSAY, D.D.S., Chengtu Sze Chuan 
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y. 
T. W. WIDDOWSON, L.D.S., London, England. 
J. E. BLACK, D.D.S., Vancouver, B.C. 
MANLY BOWLES, D.D.S., Winnipeg, Man. 
J. A. C. HOGGAN, D.D.S., Richmond, Va. 
EDGAR D. COOLIDGE, D.D.S.. Chicago, III. 
RICHARD G. Mclaughlin, D.D.S., Toronto. 



Entered as Seoond-class Matter at the Post Office, Toronto. Sub- 
scription Price: Canada, $1.00; Other Countries, $1.25; Single Copies, 25c. 

Original Communications, Book Reviews, Exchanges, Society Reports, 
Personal Items and other Correspondence should foe addressee! to the 
Editor, Oral Health, 269 College St., Toronto, Canada. 

Subscriptions and all business communications should be addressed 
to The Publishers, Oral Health, 269 College St., Toronto, Canada. 



Vol. VI. 



TORONTO, MAY, 1916 



No. 5 



H 



E D I T O R.I AL 



H 



Recent Dental Legislation in Manitoba. 

A COPY of the amendment to the Dental Act of Manitoba has 
reached us, and a careful perusal of this new legislation can- 
not but force the conclusion that our western brethren have 
taken a decided step forward. The new Act, as it now stands, will 
compare most favorably with those of other provinces, and the dental 
profession of Manitoba, while perhaps not gaining all they wished 
for, are to be congratulated on the general outcome of their legislative 
efforts. 

The outstanding features of the new Act may be summed up as 
iollows: 

( 1 ) The preliminary examination hereafter required is restricted 
to "Matriculation in the arts faculty of the University of 
Manitoba or an academic standing which, in the opinion of 
the Council, is equivalent thereto." 

(2) Power is given the Board of Directors to establish and con- 
duct a school of dentistry by itself or in conjunction with the 
University of Manitoba. 

(3) The University of Manitoba is to be the sole examining body 
in dentistry in the province. 



ORAL HEALTH 227 

(4) Graduates of recognized colleges applying for examination 
shall receive a permit to practise in the office and under the 
supervision of a regular practitioner till the next succeeding 
examination held within one year. However, no such permit 
shall be renewed thereinafter. 

(5) The regulation and discipline of the profession is made more 
stringent and is gone into in more detail. For example, it is 
defined a misdemeanor "To in any way advertise to practise 
dentistry in all cases without causing pain." 



X-Ray Plates May be Shown to Juries. 



THE Supreme Court of North Carolina, in affirming a judgment 
in favor of the plantiff for damages for personal injuries alleged 
to have been caused by having a heavy truck pass over one of 
his feet, holds that there was no error in permitting a physician who 
had made skiographs of the plaintiff's feet to exhibit the plates to the 
jury. It was true that the witness who made the skiographs did not 
says in so many words that the photograph was an accurate and true 
representation of the condition of the foot, but this was a reasonable 
mference from his evidence. 

This decision is of interest to members of the dental profession, and 
is but one of the many future developments in dentistry resulting from 
the use of the X-Ray. Under the circumstances where there is any 
uncertainty about the treatment, a skiograph is essential both from 
the patient's and operator's standpoint. Some writers would have 
us believe that the X-Ray is nothing but a "shadow of doubt." 
However, when the dental skiograph is introduced to a jury it be- 
comes a decided reality, and while it may be a "shadow picture." 
it will, we venture to think, be considered by the jury as a most 
important piece of evidence. 



Good Public Service by Mayor Cowan. 



IN the midst of Mayor Cowan's activities as Mayor of Kogina he 
finds time to devote to the best interests of the dental profession. 
Aside from his interest in recent legislative enactments in the Pro- 
vince of Saskatchewan, he has had incorporated in the Regina 
Municipal News (5,000 copies of which find free distribution in the 
city of Regina) an excellent article on oral hygiene. 1 he .\rticle 
appears under the Department of Health News. 



Canadian Dental Association. 

THE next regular biennial meeting of the Canadian Dental Asso- 
ciation will be held in Montreal on September 12, 13, 14, 13, 
1916. A large number of Canadian dentists have gone to do 
their bit in the great European conflict. Others expect to go during 
the coming summer. It is earnestly hoped by the executive committee 
that all those of our numbers who can do so will make a point of 
attending the coming meeting. An excellent programme is being 
prepared, and September is an ideal month in which to visit Mont- 
real, Quebec and the mighty St. Lawrence. 

Donations Canadian Army Dental Fund. 

THE following donations have been received by Dr. Snelgrove, 
103 Carlton Street, Toronto, Treasurer Canadian Army Den- 
tal Fund, since the last acknowledgment: 

A^en^ Brunsmck — 

Dr. J. C. Leonard, St. John $10 00 

Dr. A. L. McAvenney, St. John 3 00 

Dr. J. L. Day, St. John 3 00 

Dr. F. S. Sawaya, St. John 3 00 

Dr. L. A. Langstroth, St. John 1 00 

Ontario — 

Dr. C. N. Simpson, Port Arthur 3 00 

In addition to the above, the Wingate Chemical Company donated 

fifty tubes of anocain. The Quebec Dental Society paid $230.00 

direct to Major Clayton for the benefit of the C.A.D.C. 

Toronto Dental Society. 

Treasurer's Statement, Season 1913-1916. 
J. E. Rhind, Treasurer. 

Receipts. Expenditures. 
1915. Essayists' expenses and 
March 22. Hotel Carls-Rite for sup- 
Balance from last season.. .$197.05 pers for 4 meetings $391.70 

1 31 Membership Fees 655.00 Printing 50.00 

Visitors' Fees 6.00 Postage and Typing 31.50 

Bank Interest 7.02 Floral Wreath 25.00 

Sundry small accounts . . 5.25 

Cash Balance in Bank .... 361.62 

$865.07 $865.07 

April 10th, 1916. Audited and found correct. 

(Signed) B. F. Nicholls. 
W. E. Willmott. 



From the Billet Door. 



JOHN PRINGLE, Chaplain of No. 3 
Canadian Field Ambulance, has written 
a masterly article, entitled "From the Door 
of My Billet." The following are extracts: 
*'This war has made us alive. The only thing 
worth while in the world's life grows in the 
soil of sacrifice. We have been aroused from 
our lethargy, and shaken out of our easy- 
going, luxurious, and pleasure-loving ways, 
begotten by accumulated wealth and almost 
unbroken prosperity. It has organized our 
people, speeded up their industries, exalted 
their virtues, shown up their vices as national 
weaknesses, taught us anew the old lessens 
that man does not live by bread alone, that 
right is our vital breath. And what a 'mixer' 
this war has been ! Here we are all living — 
officers and men — practically on the same level, 
in billets, dugouts, huts, and veritable shacks. 
Here manhood counts. Human brotherhood 
is a real thing here. The effort and the sacri- 
fice will school our people out of their easy- 
going, indolent habits, give a new value to 
democratic government, a new vision of the 
purity without which true democracy is impos- 
sible." 




DONALD CLARK, L.D.S., D.D.S., Hamilton 

Member Board of Directors Royal College 

of Dental Surgeons of Ontario. 



Rff 



iU 



OPAL HEALTA 

A JOURNAL THAT STANDS FOR THE "OUNCE OF 
PREVENTION," AS WELL AS THE ** POUND OF Cl'RFr 



li 



D 



VOL. 6 



TORONTO, JUNE, 1916 



Soldering and its Difficultie s 
Invin H. Ante, D.D.S., Toronto. 



No. 6 



IN its application to dentistry, soldering has assumed the significance 
of an art of much greater importance than ever attained by the 

gold or silversmiths. However, the ease with which good results 
are obtained by the more skillful, when compared with the discour- 
aging failures of others (such as the burning or fusing of the parts or 
the fracture of porcelain facings), leads to the conclusion that the 
lesson has not yet been learned by many men. One should closely 
apply oneself in an effort to become so skilled as to render the pro- 
cedure one of simplicity and ease and reduce to a minimum the 
attending danger of accidents. 

The essential requirements for successful soldering are: 

1 . Cleanliness of the surfaces. 

2. Proper flux. 

3. Apposition of surfaces. 

4. A free flowing solder. 

5. Proper amount and distribution of heat. 

6. Proper support. 

Cleanliness. 

Cleanliness should always be strictly observed in soldering opera- 
tions. The surfaces to be united should be bright and clean in order 
that the solder may become thoroughly attached. I his can be 
secured by filing, scraping, polishing, and by treating the metal in 
the acid bath. 

Acid Bath. 

Sulphuric acid, diluted with equal parts of water, is frequently 



232 ORAL HEALTH 

used for this purpose. The parts are immersed for a few minutes to 
remove all oxidization or deposits of foreign character. By heating 
the acid bath, its cleansing properties are increased. After removing 
the work from the acid, it must always be freely washed in clean 
water. If any acid should remain, when the work is heated, salts 
are formed of the baser metals, which prevent the possibility of sol- 
dering until the parts are again treated with the acid and this pre- 
caution observed. 

Proper Flux. 

Oxidization will always occur with gold that has been alloyed 
with baser metals, due to the affinity of the baser metals for oxygen, 
taken from the atmosphere. This tendency is increased by heat. It 
being necessary to prevent oxidization and maintain cleanliness of 
the parts, different substances are used for this purpose. Borax em- 
ployed as a flux and fused over such surfaces dissolves the oxide 
which forms on the surface, while it also protects from further oxidi- 
zation by excluding the oxygen of the atmosphere. It also aids in 
the fusing and alloying. The solder should also be smeared with 
borax, because, being a lower grade alloy it is more easily oxidized. 
Bcrax is most frequently used as a flux and meets the requirements 
in every respect. For convenience, the rock or prepared borax is 
used. Make a saturated solution of powdered borax and boric acid 
in water, the solution being kept in a glass bottle with a dropper top. 
A little of the solution is placed on a ground glass slab or slate with 
the rock borax, and with a circular motion rub until a thin paste of 
flux, of a creamy consistence, is produced. This is applied to the 
particular surfaces (before heating the parts) in very small quantities, 
with a camel's hair-brush or tooth-pick, carrying it to every portion 
and surface upon which the solder should flow. 

Wax. 

All parts that are to be exposed for soldering should, previous to 
their investment, be thoroughly covered with wax. This will effectu- 
ally exclude plaster and is easily removed, with boiling water, after 
the investment has sufficiently hardened, thus producing clean ex- 
posed surfaces. A sticky wax, the writer has found very satisfactory, 
is made of resin two ounces, beeswax one ounce, Venice turpentine 
one teaspoonful. Melt in order named, thoroughly melting each 
before adding the other. Mix thoroughly by stirring and pour into 
moulds. 

Apposition of Surfaces. 
To facilitate the union between the parts, the edges or surfaces 
should be in absolute contact. If any defects of this character are 
found to exist, they should be remedied by filling such spaces before 
the case is heated, with small pieces of metal of which the work is 
be.ng constructed, thus rendering the continuity of the part complete. 



ORAL HEALTH 233 

Solder runs freely by the force of capillary attraction, between two 
closely-fitted surfaces, just as water between two pieces of glass. 

Heating and Soldering. 

The application and proper manipulation of heat in securing the 
best results is an important feature and a matter requiring both care 
and judgment. The under-valuation or over-estimation of the re- 
quired heat is frequently the means of much discouraging labor. "^ et 
when the principles are properly applied and observed, the entir-j 
procedure is quite simple. When soldermg bands, cusps, etc., and 
no investment is necessary to sustain the relation of the parts, the 
work is more easily accomplished; but when investment is used, thj 
process is a somewhat more difficult task. 

The case should always first be placed upon a bunsen burner and 
gradually heated to exclude all moisture from the investment, and 
left in place long enough to become thoroughly heated (13 to 30 
minutes), which point is indicated by a dull red color. 

Solder. 

The solder used should possess the quality of flowing freely and 
be as high in grade as the attainment of that property will permit, so 
that it will sufficiently resist the action of the fluids of the mouth. It 
should also approximate as nearly as possible the color of the metal 
upon which it is used. For convenience, solder should be in plate or 
strip form, about twenty-six gauge, and cut into sizes corresponding 
to the extent of the parts to be united. A small piece of high grade 
solder (such as 20k) should be placed near the top of each joint 
where backings come together, and also at the point of union betw.^en 
backings and cusps or plate. If facings are used, a piece should be 
placed over the pins just large enough to cover facing. 1 hese pieces 
of solder are made to adhere to their {:w-oper position through the 
agency of the flux. The excess solder for filling in the work, which 
may be of a lower grade (18k or 20k), is cut up into suitable sizes or 
in strip form and kept in readiness on the borax slate or glass, where 
it will be handy for further use when finishing the soldering operation. 

Heating Up. 

With the brush flame from the blow-pipe the temperature should 
be raised very gradually, in order that the pieces of solder nia> not 
be displaced by the puffing-up (incident to the calcination of the 
borax), or that the facings or porcelain teeth may not be fractured 
by too sudden an elevation of temperature. All parts should be 
brought to an equal temperature. Should one part become sufticiently 
hot while the other remains comparatively cool, the solder when fused 
will flow upon and adhere to and have a preference for the hottest 
portion. The brush flame from blow-pipe should, as a preliminary 
step, be directed to the under surface and around the case especially 
upon the heavier metals or bulky parts, as crowns, saddles, facings, 
inlays, etc. 



234 ORAL HEALTH 

Soldering. 

When the case is thoroughly heated and the temperature raised to 
the fusing point of the solder, the small pieces of solder previously 
p)Jaced upon the surfaces will begin to fuse and settle down. The 
oxidizing or pointed blue-flame of the blow-pipe should now be 
directed upon the solder and each layer is thoroughly fused before 
adding more. The excess solder is consecutively applied in fairly 
good sized pieces or long strips, until the case is filled in and the 
restoration of contour is obtained. 

The fusing and flowing of the solder in the desired location and 
direction may be facilitated by using the sharpened point of a slate 
pencil, bicycle spoke, or hat-pin to pull, push or guide the solder 
(when in the fused or plastic state) to the desired point, after which 
only sufficient heat to smooth the surface should be applied. 

Cooling. 

When the soldering has been completed, the case shouJd remain 
over the flame for a few moments to prevent too rapid cooling and 
the consequent sudden contraction or shrinkage. The flame may 
then be turned off, and if porcelain facings are present, the case is 
embedded in asbestos fibre, plaster or pumice and allowed to cool to 
the point where it may be comfortably handled. It may then be 
removed from the investment, cleaned in acid and finished. 

Solder **Balling-up." 

Solder "balling-up" is invariably the result of the heat or flame 
being directed upon the solder before the surrounding parts are equally 
and sufficiently heated to permit of alloying. A poorly alloyed solder 
will also ball up, even though the case be sufficiently heated; this is 
indicated by dark or copper colored streaks running through the 
solder. When solder balls-up and the heat is continued upon it, the 
basei" alloys contakied in it (zinc especially) may be burned or 
volatilized out. This loss will increase the fusibility and decrease 
the flowing properties to such an extent as to cause the melting or 
burning of the parts. When solder balls-up, remove the flame, thor- 
oughly flux the balled-up solder, and cover over with fresh pieces of 
solder, well smeared with flux, apply the heat and observe the sug- 
gested precautions. 

Burning. 

The fusing or burning of parts is the result of too much heat being 
directed upon the work after the solder has begun to fuse; or over- 
heating one particular part by the flame being directed and held too 
long upon it. This latter being a common result when one is trying 
to flow solder upon a dirty surface. 

If the work be melted (which is indicated by the presence of small 
or large perforations in the surface of the work) it will be necessary 
to resort to some means of filling-in or repairing. This is best accom- 
plished by what is known as the sweating process. Small perfora- 



ORAL HEALTH 235 

tions may be filled in this way by first thoroughly cleaning the surface 
by scraping or filing, flux thoroughly and then place in position a 
piece of solder somewhat larger than the perforation, and with an 
oxidizing flame from the blow-pipe apply to the parts around the 
solder. Heat until the solder settles down, then apply the flame 
direct until it becomes firmly attached without complete fusion. When 
the perforations are too large to bridge over with solder, a piece of 
pure gold plate (backing) of suitable dimensions is fitted and bur- 
nished into the opening, and the surrounding surfaces cleaned and 
fluxed. The solder (well fluxed) is placed in posit on covering the 
same, and with the same procedure as indicated above, the operation 
is completed. UNSOLDERING. 

It is frequently desirable to observe certain precautions to avoid 
the unsoldering of the parts previously united, such as the seams on 
bands or the cusps and band. This is easily prevented by coating 
such surfaces with prepared anti-flux or solution of whiting or plum- 
bago in alcohol or water. As a preliminary precaution such joints 
or seams should be soldered with a higher karat solder, 22k for 
instance. Small Holes. 

The presence of small holes or perforations on the surface of the 
metal is not an unusual occurrence. This may be caused by the 
presence of baser metals (lead, tin, zinc, etc.), which may become 
attached to the gold by contact with the dies in swaging, the bencfi, 
or from a file containing the same. This may be avoided by heating 
the pieces in an acid bath (equal parts sulphuric acid and water) 
immediately preceding the heating of the metal. Perforations or 
borax holes are common on soldered surfaces. This is largely caused 
by the borax being retained between the layers of solder and incom- 
plete fusing of same. To avoid, use a mmimum amount of borax 
the liquid rather than the dry. Also during the process of soldering, 
thoroughly melt or fuse each layer of solder before adding more, and 
the final layer should be thoroughly fused so as to produce a smooth, 
unpitted surface. Lower karat solders pit more easily than the higlur. 
due to the presence of a greater amount of baser metal. 

Shrinkage. 
It is necessary to use the utmost precautions toward preventing the 
possible change in the relation cf the parts, which would interfere 
with the fit and adaptation of the work. 1 he shrinkage of gold 
solder increases in proportion to the quantity of baser alloys incor- 
porated. Thus the lower the karat or grade, the more shrinkage. In 
extensive work it may be further prevented by first soldering the parts 
separately, then in the final assemblage of these parts very little 
solder is used to secure union and strength. Very large bridges 
should be divided and soldered in sections and then subsequently 
uniting the sections. 



236 ORAL HEALTH 

In the assemblage of heavy posterior bridges, wlnere a great bulk 
f "iSr fs usTd if is always desirable to carry to the deep portions 
°o The work as sin a quLt.ty of solder tn the melted state as .s 
pos^ile a one time. The bulk may then be frlled m w.th copper, 
brlss German silver, scrap gold, platinum w.re. gold w.re or gold- 
filed or gold lingual bar wire, the latter bemg preferred Then 
thoroughly cover over with the gold solder. The value of the use of 
these in this manner is in order to mm.m.ze the shrmkage 

The change in the relation of the parts, caused other than by 
.hrlkageo" carelessness m investmg. is rare. The few mmutes that 
might be expended in verifymg the relation of the parts may save 
hour of work. If the mvestment cracks when heated, the parts rnay 
be held together with measurement wire if one is sure of the correct 
relatcn. or the work is allowed to cool, and sticky wax is flown into 
he bridge parts. Then break off the old investrnent. verify the rela- 
tion of the parts by returning to the original model and then reinvest 
he bridge in a good investment. The cusps o a posterior bridge 
may, during the process of soldering, draw from their correct position, 
owfng to the shrinkage of the solder. This may be overcome by 
pracing an L-shaped strip of gold (about 3mm. wide and Omm^ 
long), hooking the small or top end of the L around on to the Imgual 
surface of the cusps and the other end extending into the investiiig 
material. CONTOUR. 

The proper contour is rather hard to determine, but with a httle 
experience in soldering it becomes quite easy to produce the desired 
effect. When soldering, it is always desirable to observe the laws 
of gravity, for while it is true that solder will follow the heat, its flow 
may be so controlled only in the smaller cases. When used in large 
quantities, especially in large cases where the curvature is great, its 
weight will naturally cause it, when fused, to seek the lowest point. 
Thus the position of the work should be changed as the soldermg 
progresses in order to retain, in the desired location, the solder mass 
when it is m the fluid state. The use of reinforcing wire (as sug- 
aested under heading "Shrinkage") will also be found advantage- 
ous. A piece of plate gold may be so shaped and htted into the 
bridge to produce the desired contour and inserted during the pro- 
cess of soldering. FRACTURE OF PORCELAIN. 

The difficulties most frequently experienced in the checking or 
fracturing of porcelain during soldering is, in nearly all cases, due to 
most trifling mistakes. A facing is made of two distinct substances 
the porcelain and the platmum pin, each of which possesses physical 
properties differing when subjected to heat. The porcelam absorbs 
heat very slowly, while the platinum absorbs it very rapidly. Thus 
the heat must be applied gradually and uniformly in order that the 
expansion which takes place in each may occur evenly. 



ORAL HEALTH 237 

When fractures occur across the surface of facings mesio-distally, 
they are invariably caused by too sudden elevation of temperature, 
such as the oxidizing flame of the blow^-pipe being directed upon the 
facing before the solder has started to flow^. This causes a rapid 
expansion of the platinum pins, and the expansion of the porcelain 
being not sufficiently rapid to accommodate that of the pins, the 
facing is cracked across its surface. 

Longitudinal fractures on the mesial or distal edges, or the scaling 
off of the porcelain face, may be from impingement caused by the 
shrinkage of the solder and by too close adaptation of the facings or 
parts to each other. Scaling off of the porcelain face may also be 
caused by carelessly bending the pins (to retain the backing) in such 
a manner as to produce a constant strain en the porcelain surround- 
ing their attachment. Always file the pins about half way through 
on the opposite side to the direction you wish to bend them. Small 
checks m the porcelain along the incisal edge may be from over- 
hanging edges of the backing tips or cusps or an excessive amount of 
flux used. The contraction of these cause an impingement upon the 
edges of the facing, which results in checking. The backing should 
be filed flush with the edges, and the cusps or tips be so adjusted to 
iorm a butted joint. 

Fractured facings are also caused by faulty adaptation erf the 
backing to the facmg, or the perforations in the backing being much 
larger than necessary for the reception of the pms, thus permitting the 
solder or flux to run in between the backing and facing, the contrac- 
t'on of which may fracture the porcelain. The backing surrounding 
the pins should be burnished closely to same and adapted to the 
facing with some form of swager or press. It is also claimed that 
many of the facings are checked during the process of manufacturing 
them. These, of course, we are not responsible for. 

Burning the Color Out of Porcelain Facings. 

Destroying the coloring matter in facings is very rare in most of 
the porcelains that are on the market to-day, but in some makes of 
teeth the color is very easily destroyed. It may be caused by a long 
and continued heating at a high temperature, or an excessive amount 
of Portland cement being used in the investing material. 

Support for Work. 

When soldering with the flame of a blow-pipe, it is necessary to 
perform the operation upon a support made of some suitable body. 
Supports are of two tyj:)es, namely, blocks composed of charcoal, 
asbestos, or magnesia, and appliances serving the double purpose of 
holder and heater. The charcoal block is best for certain cases. It 
adds to the heat of the blow-pipe flame and thus aids in the fusing 
of the metal. It is the most suitable for small work, the only disad- 
vantages being that it is black and brittle. These disadvantages, 
however, may both be overcome by encasing with tin and set in 



238 ORAL HEALTH 

investment material. The charcoal is rapidly consumed. The 
asbestos block is clean, durable and fireproof, but otherwise has 
nothing to commend it. The magnesia block is compact, clean, quite 
durable, and so soft that some forms of work may be embedded in 
its surface and thus be better supported. Invested work is often 
supported by embedding into asbestos fibre, pieces of coke, pumice 
stone, fire clay, or chunks of investment material placed in a pile 
on an asbestos pad. 

The combined support and heating appliance is, however, the 
most commonly used. The work is placed upon a piece of iron gauze 
(metal lathing) and then placed upon the spider over the flame of a 
bunsen burner. A very simple, most useful, and economical support 
is to line the sides of a small granite or aluminum saucepan (4 inch 
diameter by 2 inches deep) with sheet asbestos. Punch small holes 
in the bottom to allow air to enter for combustion. The work is 
embedded into pieces of coke or pumice about the size of marbles 
held in this dish. The handle on the dish is used to turn or tilt it 
during the process of soldering, without disturbing the case. After 
the soldering is complete, the case remains in the dish and is allowed 
to cool. 



Post-Graduate Class in Dental Prosthetics 



AT the request of the Dean of the Medical College of Virginia, 
and for a number of other reasons, the place of meetng of the 
annual class in dental prosthetics will not be Toronto, but the 
charming southern city of Richmond, Virginia, a little over a night's 
run from Toronto. Following the increased amount of extraction of 
teeth as shown necessary by the X-Ray, and the resulting change in 
the sanitary and engineering aspect of these mouths, and the design 
of restorations for these, has led to a remarkable demand for infor- 
mation, especially as touching partial dentures. Dr. Cummer, whose 
lectures, demonstrations and models in partial dentures are exception- 
ally complete, and embrace some fundamentals in design new to 
many, is under arrangement to present this subject in Salt Lake City, 
Utah; Portland, Oregon; Spokane, Wash.; San Francisco and Los 
Angeles, California, before meeting the class in Richmond, and sub- 
sequent to that before the Ohio State Dental Society, Dayton, Ohio, 
in December. The course in Richmond will be given in the early 
part of August, and will be an opportunity for those interested in 
the prosthetic side of dentistry. Those interested would do well to 
communicate with Dr. J. A. C. Hoggan, c-o Medical School of 
Virginia, Richmond, Va., U.S.A. 



Partial Dentures 



W. E. Cummer, D.D.S., L.D.S., Professor Prosthetic 

Dentistry and Applied Dental Physics, Royal 

College of Dental Surgeons, Toronto. 



(ConliniK'd from April i-,-,iic) 

Impressions. 

THE Greene method of impression, with its modifications, is pre- 
eminently the scientific and effective method for edentulous cases, 
and while the exact result in peripheral adaptation and non-in- 
terference with muscle action is of paramount importance in securing 
maximum adhesion and comfort in the above, yet in the many partials 
even in which retention is provided mechanically, and in which adhe- 
sion is not of paramount importance, the principle of muscle trimming 
is of advantage. For cases involving the posterior teeth, with most or 
all the natural anteriors standing, the tray may be cut away over 
the anteriors, the impression made and muscle trimmed, and after 
finished, the labial surfaces "cored" in with an additional piece of 
compound laid across the front of the teeth and pressed in with the 
lip, with the main impression in place. (Fig. 30.) In all cases of 

TCtAY 

cuowH esARin/a ) 

RETAIN INC J 

£u£il£i>/T 

COR.B A/ \ \ ^r«4r 

Fic, 30. 

Fig'ure 30. — Showmu section ol" a muscle tiimiufil c.ympouinl iuipre.-sion with 
core, and thin film of plaster foe initials (see Fiy. ir>) in which adhe.nlon t* 
desired as an auxiliar\- ictaiiiinK loice. 

teeth to be fitted, with abutments of any description present, the corn 
pound should be cut away and a thin layer of plaster introduced, 
having the patient raise the tongue and move lip and chock to pre- 
vent plaster covering already muscle trimmed |)enphery. 1 he im- 
pression having been made each crown, post and cope. etc.. drawn 
with it should be given a layer of soft wax or oil which will allow 
its easy withdrawal from the cast. In most cases, other than such as 
above, plaster is indicated, either by entire or sectional method. 




240 ORAL HEALTH 

Cast and Antagonizing Cast. 

Weinstein's, Spence's plaster compound or sorrel stone makes a 
model approximately four times as dense as plaster, a decided advan- 
tage. The materials should be thoroughly spatulated to a consist- 
ency of putty, and packed in with wooden sticks into the recesseo in 
the impression made by the teeth. For antagonizing casts in which 
correctly made full dentures, dentures and natural teeth, and natural 
teeth alone nothing is as good, following a method of Dr. R. Gordon 




Figure 31. — Method of Dr. H. E. S. Chayes, of New York City, in fitting- 
impression bearing- inlays crowns, showing' varnished and oiled impression, 
inlays (with uncut sprues) with one shape cement processes built out into 
space; plaster subsequently added to dotted line. 

McLean, as a plaster impression half way down the necks of the 
teeth into which may be poured Melott's metal almost before the 
plaster is set. In articulating, the interfering points of porcelain 
blacken from the Melott's, acting in the same manner as carbon 
paper, and is a great convenience. 

Should plaster be used for casts, all the precautions against expan- 
sion, non-overstirring, non-use of K2 S04, no delay in pouring of plas- 
ter impression, thick heavy cast, subsequently cut down, etc., should be 
observed. Portions of the impression bearing crowns, posts, and 
ccpes, inlays or similar after these are waxed or varnished sufficiently 
to fcrm a film of intermediate material, may be packed with cement 
with cone processes reaching into space prior to the filling with 
plaster. (Fig. 31.) The cast having been poured, slight heat, suffi- 
cient to melt varnish or wax, allow easy removal of inlay, post and 
cope, etc., and accurate and frequent replacement. In instances of 
large saddles in which reswaging is indicated, the use of first named 
series of materials is indicated. 

Bases. 
For the saddles of partial dentures, gold is the material which con- 
forms to the requirements in the very best sense, susceptible of a high 
polish, capable of assembly with solder, thus occupying a minimum 
of space, and of sufficient strength, properly alloyed, for unobtru- 
sively formed parts. For small saddles of six teeth and under, cast- 
ing by the indirect method is expedient, using a thin wax of 28 gauge, 
applied carefully to cast, covered with French chalk, rubbed in, pre- 
venting adhesion, wire rim retainers space for Gilmore attachment, 
etc., all worked in in the wax, as well as suitable gates and air 
escapes (the writer would like to mention the Mathews Wax- Wire 
Former in this connection) (Fig. 32), and this half-invested. The 



ORAL HEALTH 



241 



half-invested and thus stiffened wax may be Hfted from the 
model, the investing completed, and the saddle cast (Fig. 33) and 
returned to the model for assembling with the retainers, rests, etc., 
necessary to complete the base of the partial denture. Aluminum 
may be used in a similar manner, different in that ordinary base- 
plate wax may be used, which is of sufficient rigidity to be mounted 
directly with one operation on the sprue wire; but the attachments 
must be made of rubber, and the saddles heavier, making a more 



© 




i*^^^^*^|^^^^^^ 



iVWuiiltVM.S!,k»rtif 




Figure 32. — ^ZNTathew's wax wire foi-mer, a iiio.st useful laboratoiy acce.<.<ory. 
To be filled with wax. warmed ovei- flame, and on in.<ertion of variou.s nozzles^ 
.shown above, wax in wire form of corre.spondins different .size.s and .^hape.*?, 
round, oval, etc., i.s readily expre.s.sed. It i.s intere.sting to note that manufac- 
turer.s are planning to give u.s wax in variou.s .shaped and .sized rods for casting 

obtrusive if less expensive part. In the mind of the writer the above 
process for casting aluminum is so quick, easy and cheap that rubber 
bases need seldom, if ever, be used, a decided gam in sanitation. 

Size, Position, Etc., of Bars, Indirect Retainers, Etc. 

Regarding the size of 18k stiff oval bar used in joining the saddle 
elements of partial dentures, etc., from 6 x 12 to 8 x 13, Brown and 
Sharpe gauge, depending on the amount of leverage, large or small 
stress given by the patient, etc. Concerning the position of the lower 
bar, the least obtrusive position has been found as low down as the 
muscles of the raised tongue will permit without chahng; in a cast 
made from a muscle-trimmed impression at the lowest point behind 




Figure .S.S. — Steps in investin.i; saddle by indire<'t retention. (a» *'aM. .ox - 
ored with French chalk rubbed on. (b) 2S gauge wax laiil down, w.as wire i im. 
retainers, gates and vents in position. (») Pitto, half invfsted (investment 
applied with camel liair brush). 



242 



ORAL HEALTH 



the alveolar process and 2 mm. back, and inclined the same direc- 
tion as the lingual surface (Fig. 34A). This may be easily done by 
cutting a tinfoil pattern (Fig. 34B), straightening this out on a flat 
surface, and bending (Fig. 34D) the oval bar against the wider cross- 
section to a position corresponding to the pattern, then completing 
the bending against the small cross-section, giving the adaptation 
shown in Fig. 34A. As compared with Fig. 34E, bent against 
narrow cross-section only. Sharp right angle bends are accomplished 
by cutting a 90 degree angle in the bar, bending up, apply flux and 
small panel of solder, and soldering over bunsen. Angles less or more 
than 90 degrees may be found by cutting the angle complementary to 
180 degrees in the bar bending over, and soldering in like manner. 
(Fig. 34 F, G and H.) 

The size of the upper bar varies as to its requirements similar to 
the lower, and its position is touching the upper vault, except for a 
millimeter or less over the hard central area allowing for "settling" 



CUTTING AND BENDING OVAL OR ROUND BARS. 







ao' 


t- 1 


V/ 1 


^ 


<■] 1 


V I 


HI 


.mj" 



32: 



11^ 



HO 



o a o 

CfO-i-qo ~ liO L OF oor 

(^Oi^fi^iMLrirfiiKY TO lia' 



o o o 



OlTT-o 



m i- 1^0 - 1<(0 ^,^^^. 




Figure 34. — Bending and cutting oval bar for various curves, angles, etc. 
(a) Position of lingual bar. (b) Tinfoil pattern, cut and fitted against model, 
then flattened, (c) Oval bar unbent, (d) Oval bar bent against widest cross 
section to tinfoil pattern using pliers. When the bending is finished against 
narrow cross section the bar will assume form in Figure A. (e) If bar is 
bent in one way only against narrow cross section it will assume shape in 
Figure E. 



Rule: File or cut angle complementary to angle desired. 

F.— 90° angle (right), desired cut 90° angle, bend to 00' 
G. — 140° angle (right), desired cut 40° angle, bend to 140' 
H.— 40° angle (right), desired cut 140° angle, bend to 40° 



ORAL HEALTH 



243 



and coming about opposite the second molar is as far back as pos- 
sible, keeping about one-quarter inch ahead of the soft palate. 
Should construction call for bar further forward than this, a half- 
round section or flat section of two thicknesses of "sweated" metal 
should be used (Fig. 34, 35 and 29F). For wire for joined indirect 






Al A2 

Figure 35. — Size and shape of upper bar. 



A3 



At, A2, A3. — Suggestions for constructing bar.s in different po-sitiona of upper 
mouth. 






WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



H.- — liestoratidii with upjivi- b,ii' opposite second molar 




ffortOl 




6P MUfAU^ 




WITHOUT DENTURE 



DENTURE (UPPER) 



WITH DENTURE 



l''igure ('. — Same restoration, keeping ail coiislrurl ion aluad «>; iii.>t wi.»l.ir. 
Bars A2 or A3 might be used, or one sheet of 2»> gauge gold. 

retainers, clasp to base. Roach split-tube, etc., a 14-gauge B. & S., 
rolled slightly, answers well. 

Care must be taken in bending the indirect retainers to keep them 
away from the gingival (Fig. 29F). 

Note. — Often bars, indirect retainers, etc., may be unobtrusively 
placed in between rugae. 

Assembling of Metal Parts. 

The various parts as retainers, rests, saddles, bases, etc.. having 
been united (using ground asbestos wet (Neutralite), or the hory 
soldering pliers (Fig. 36) for parts not requiring exact relationship, 
as the wire on the Roach split tube, the 14-gauge wire on a clasp. 



244 



ORAL HEALTH 



etc.), assembling these partly assembled pieces with wax (always 
heat pieces to be waxed together and flow wax thereupon before 
waxing together, thus preventing separation), and investing with a 
standard investing material. This having been satisfactorily corn- 




Figure 36. — Elliott soldering- pliers and stand, a useful adjunct for rapid sol- 
dei-ing- without investing- simaill parts, as clasp on 14 -gauge wire, Roaoh attaclh- 
ment to inlay, split tube to 14-g-auge ware, etc. 

pleted, and its accuracy checked frequently and finally by trials in 
the mouth, held together by both wax and subsequently solder, wax 
trial plates may be built down, and the process of "taking the bite 
begun. 

Taking the Bite. 

Unless there are a sufficient number of upper and lower natural 
opposing teeth with defined occlusion in contact, making possible the 
accurate placing of the casts in the position of the rest bite, trial plates 
with built down wax rims are necessary. In most cases, details 
associated with full cases, as amount of separation of the ridges, 
median line, facial contour, etc., are already supplied by the teeth. 



ORAL HEALTH 245 

and the first step is usually the securing of the rest bite, also simplified 
by the presence of teeth as land marks. The next step, the placing 
of the models in the anatomical articulator, is accomplished very 
easily by either the Snow face bow, or the Gysi registering instru- 
ments (the latter which serve to trace the condyle path, lateral move- 
ment, etc., and rotation point tracing). (P. 171, etc., Clapp Pros- 
thetic Articulation.) In the Snow face bow bite stem No. D (Fig. 
37), the lower may be fastened to the articulator first, the face bow 




1/ 

Figure 37. — ^Steni No. D. Snow face bow. 

and stem removed, and the upper fastened to the lower by the indents 
in the upper trial plate, from the natural teeth. With Professor 
Gysi's instrument (horseshoe plate) the process is the same. (P. 189, 
Clapp Prosthetic Articulation.) The ascertaining of the inclination 
of the condyle path, lateral movement, and position of the rotation 
points may be obtained from patient and incorporated in the articu- 
lator, so far as the writer's knowledge goes, only by the registering 
apparatus and adaptable articulator of Professor Gysi's. 

Anatomical Articulation. 

Nowhere is the observance of established principles relating to the 
movements of the jaw and harmonious arrangement and formation of 
the teeth of more importance than in the construction of partial denture 
— removable pieces. Interferences of porcelain in side movements of 
the jaw in mastication has resulted in the failure of many an other- 
wise perfect piece of work, as has non-interference of porcelain or 
gold accounted for at any rate the comfort of other fearfully shape- 
less pieces of restoration. (Figs. 38 and 39.) The correct registry 
and reproduction on the articulator of the condyle path, and more 
important than that, of the lateral movement and rotation centres as 
well as correct placing of casts in articulator is of utmost importance, 
and furthermore, even with the Gysi system, is simple, adaptable to 
all cases, and within the reach of any average practitioner, and elim 
inates possibility of failure from this source. (P. 171. 172. etc.. 
Clapp Prosthetic Articulation.) 

The condyle path may be secured by the protrusive bite in e\ent 
of lack of the Gysi registering frame. 



246 ORAL HEALTH 





Fig 38A.— Incorrect. Fig. 3SB. — Correct, 

Schematic representation of the correct and incorrect theories regarding the 
i-novement of the mandible at the condyle during lateral movement referred to 
in text. It has been supposed that when the jaw was swinging to the masti- 
cating side that it was simply swinging in a rotary movement with the opposite 
condyles as centre. Professor Gysi has shown this to be incorrect, and that In 
the lateral mastication movement the whole mandible moves inward laterally as 
well as forward, while on the other side the condyle, instead of merely rotat- 
ing (Fig. 38 A), moves slightly outward (Fig. 38B). See also Figs. 39A and B. 

Fig. 38 A shows rotation point 13CM. apart from the greatest distance, and 
to the distal. In a side movement, say towards the left of the page, the jaw is 
swung-, not from the condyle, but at the left hand R, the rotation point. The 
condyle nearest it takes the short path, the ends of which are joined to the 
two short radii running from R, and the condyle farthest away from R followst 
the longer paths, the ends of which are joined by the two longer radii from 
R. The heavy lines, therefore, denote the travel of the condyle in the glenoid 
fossae. Note also the oblique lines running from the centre of the teeth them- 
selves, which represent the travel of the upper lingual cusps in side move- 
ments. In a side movement towards the left of the page, the lingual cusps on 
the upper on the right side of the page would describe areas obliquely forward 
on the occusal surfaces of the teeth on the right side of the sketch, while on 
the masticating or side nearest the rotation point the cusps of the upper travel 
buccally through the intercuspal spaces. Fig. 38B is similar to Fig. 38A, 
except rotation points on 7 cm. a,part instead of 13 cm. If the mandible swings 
say to the left of the page, the jaw swings from the left hand R or rotation 
point, and on the left side the condyle describes the short arc of the circle 
with R as centre, joined at each end by the two short radii; while on the 
other side the condyle travels forward, describing the arc touched at either 
end by the longer radii from the left hand R. Note in Fig. 38B the difference 
of the'ousp travel in the two lines described oy the lower cuspid, one with 
rotation points at 7cm. and the other at 13 cm. Note also that with widely 
separated rotation points and forward travel of the cusps of lesser obliquity 
as in Fig. 38A, admits of greater cusp height and overbite, as shown by small 
sketch at side of the page, while in Fig. 38B, with rotation points close together^ 
the forward of the upper lingual cusps in the masticatory groove of the lowers, 
is more strongly oblique, necessitating lesser cusp height and overbite, a.^ 
shown at the side of the diagram. 



ORAL HEALTH 



247 




ii cr*. 



FiK. y,).\. 



ICH 




Vi'A. :^.tH. 



248 ORAL HEALTH 

Choice and Arrangement of Teeth. 
The close proximity to the artificial teeth of partial dentures as 
well as crowns and bridgework of the natural and living teeth make 
the problem of color and form the most difficult of all. While the 
teeth offered to the profession to-day, resembling as they do the cry- 
stallized knowledge of some of the brightest minds in the profession, 
such as Drs. Williams, Gysi, and others, yet in partial denture con- 
struction, alterations in form and color are frequently necessary. The 
imitation of receded gums, with considerable length of root showing 
(Fig. 40) different stages of wear, overlapping, erosion, cracks in 




Figure 40. — Grinding- teeth to imitate recessed gum. (a) Tooth, correct 
width, but too long, (b) First cut, outlining- mesial and lingual side of root, 
(c) Second cut, outlining mesial and lingual side of root, (d) Third cut, out- 
lining mesial and distal side of tooth, (e) Fourth cut, outlining- labial of tooth, 
(f) Cuts smoothed and rounded with disc and "gloss stick." 

enamel, characteristic forms varying from ordinary, chalky spots and 
creases in enamel to brown stains from tobacco, etc., occurring in 
corresponding teeth on the opposite of the arch should be repro- 
duced with greatest fidelity. A careful selection, with the articulator 
and models carrying the assembled frame work in the hand, with full 
details concerning the shade at hand are necessary, following that in 
some cases the use of the stone, discs, porcelain polishing materials, 
and porcelain stains. Dr. Wilson's text. Dental Prosthetics, P-501, 
gives details concerning this most important branch. 

Articulating. 
The front six should be adjusted satisfactorily and tried in the 
patient's mouth before any of back eight are adjusted. Incidentally, 
at this stage might be mentioned one of the great advantages of the 
assembled and soldered gold base, as at the time the assembling of 
the various parts forming the base is complete, the retainers are ad- 
justed and the piece fits positively into place as when completed, and 
the teeth firmly waxed thereupon an exact counterpart of the future 
denture is available for inspection and study; lacking in vulcanite 
and aluminum pieces, gold dummies and occlusal surfaces of crowns 
may be formed in wax either in the mouth (Fig. 41), or against one 
another, or against porcelain or plaster reproductions of natural teetn 
as the case may be, or porcelain teeth against Melott's or Spence's 
compound lower, the former showing the high spots black. Side and 
protrusive movements should be given as each tooth is added, and 
interference corrected with the stone if necessary. In case of too 
limited space for porcelain teeth, the tooth of the series desired may be 
mounted in the swager ring with Kerr's compound, a piece of pure 
gold of 34-gauge adapted directly to the porcelain tooth, filled with a 



ORAL HEALTH 



249 



20k. solder on asbestos, and with the addition of a loop, a perfectly 
accurate replica of the occlusal surface of the tooth (save for the 
thickness of the gold .006") (Fig. 41 A) may be rapidly secured. In 
event of insufficient space even for this; the writer has secured good 
results by securing side movements on wax, added directly to oojd, 
saddle, carving, and casting directly to saddle. 




Figure 41. — An eng^raver's "blork." (I'rice .$7.0i) a!Kl upwards, in jeweller.-^' 
supply hou.se.s.> A univer-sally movable revolving vise, in which engravers rl.anip 
variou.s articles to be engraved. A bridge, ciown or inlay, in which it is desired 
to deepen the sulci with a diamond-shaped engraving- tool, placed in the swager 
ring with Kerr's compound, and clamped in above, ma\- be woi-ked upon with 
greatest facilitx' with the engraving tool. 




r^ 







Figure 41. \. — Special tooth foi- siioil bite i;. i)i'. lo. inouiit. W in swag;er rinii 
with pure gold (34 guage) swaged ovci- it. ('. I'uie gold occlusal surl'aoe 
removed Jrom tooth. D. On asbestos block, liiicd with solder .and IS gauKe wire 
insei-ted. 1*]. ^\'iI•e bent down forming loop. 

Converting From Wax to Vulcanite, Correcting, Etc. 

All the known precautions should be observed, namely, the non- 
use of hasteners in plaster, use of Spence's plaster compound. Sorrel 
stone or Green curved metal reinforcement for teeth similar for casts, 
non-overstirring of plaster, use of springs, careful packing, gate cut- 
ting, etc., with proper scoring, as many as possible retainers, and a 



sharp finishing edge on metal base (Fig. 42) 
be encountered. 



No shrinkage should 




Figure 42. — Cross section ol" metal cast saddle. shi>win,; .Tbrupt nnixhiric 
edge, spurs, etc. Tooth and vulcanite attachment slu»wn in dottetl line-* 



250 



ORAL HEALTH 



J he cases may thus be returned to the articulator, having been 
polished, and any necessary corrections made with a mixture of 
medium carborundum and glycerine (P-214, Clapp, Prosthetic 
Articulation), or carbon paper, or, if only one arch is restored, by 
the mere rubbing of the Melott's antagonizing model and a slight 
grinding of marked points. 

Upon returning to mouth the only possible correction that should 
be necessary should be the final slight adjustment with carbon paper, 
giving the natural teeth a larger percentage of stress, and the pos- 
sible final adjustment of the retainers, indirect retainers, etc. 

Illustrative of the foregoing, the writer believes an example of a 
definite restoration, giving each step, will be of assistance. 

Condition, upper: Four badly broken down molars, first and 
second. Upper first left abscess, long standing, level with gum, ex- 
cept distal wall, which standing in good condition. Anterior ten 
absent and absorption complete. 

Restoration, upper: Gold crowns, above gingival margin, 14 
gauge wire carried distal from each of second molar crowns 2mm. 
above gum. Roach attachment for first molar, distal horizontal wire 
for indirect retention. Denture-cast gold saddles, vulcanite attach- 
ment with Roach attachments and distal rests. (Fig. 43.) Lower 




WITHOUT DENTURE 




DENTURE (UPPER) 




WITH DENTURE 



Figure 43. 

condition so-called hygienic bridge in healthy condition on left from 
lower first bicuspid to lower second molar, anterior six and lower 
right first and second bicuspids, all in good condition, rest absent. 

Lower Restoration: Bar lower, with stud engaged in hole made 
in bridge (in mouth), indirect retainer below first molar or bridge, 
with clasp and bar joined to gold saddle carrying teeth on right. 
(Fig. 44.) 




Figure 44 



ORAL HEALTH 



25! 



Steps: Upper (begin first because of treatment). 1. Upper left 
first molar (first because of abscess), caries removed, canals thor- 
oughly opened and washed, Howe screw post fitted diagonally 
using Hood's angular hand piece, with Howe screw post drill in 
engine, and S. S. White actuator (Fig. 45) working tap, and subse- 
Y 




Figure 45. — The S. S. White Howe Sciew l*o.st .System and Aotuatcji. la^ 
Howe .screw po.st drill for right angle handpiece, (b) Howe .«crew po.<t top for 
right angle handpiece. (c) Length.s of .screw po.st. (d) (e) Instrument for 
placing Howe screw po.st. (f> (gj Right angle hand piece and actuator. The 
actuator fit.s in the engine end of handpiece. 

quently screw driver with Howe post into position, in cement. Gutta- 
percha cones in canals, silver nitrate to dried dentine. Onderdonk or 
Ivory matrix, pack amalgam; remove gutta-percha cones before 
amalgam sets, seal in formo-creoso. (See Fig. 10.) 

2. Treat, fill and restore upper molars, prepare for crowns, treat 
with silver nitrate, make small compound impression of each pair, 
fill with Spence's plaster compound. 

3. Fit bands to each of above (four upper molars), try in mouth. 

4. Heat left pair of crowns, dip occlusal ends in two-ply softened 
sheet wax, trim and slip in mouth, asking patient to close gently (to 
separation desired) and make side movements. Remove, trim, carve 
cusps and casts. Over right pair solder floors of pure gold (no 
opposing teeth here yet). 

5. Add yellow wax to inside of each of the bands of the crowns, 
press home, fill with Spence's plaster compound, reburnish. (See 
Fig. IX.) 

6. Returning to model, fit or make special tray (if patient has an 
old type denture push compound in and fit stock tray or make pat- 
tern for cast aluminum tray on this. Take impression. Byrtis or 
Neilson plaster, having patient make whistle and smile movement.^ 
massage lips, add wax inside of crowns for easy removal, make 
Spence's plaster compound cast, with crowns mounted thereon. 

Lower: I. Drill hole in bridge, size of 14 gauge wire, tit planter 
or compound cores below bridge. (Fig. 46.) Fit wuc to hole. 




Figure 4fi. — Showing po.^ition of cores, wire. etc.. for iin|>r.v<sioM of lower. 



252 ORAL HEALTH 

2. Make separate plaster impression of lower right second bicus- 
pid, pour in Melott's metal, form clasp from tinfoil pattern, using 
contour and other pliers and small steel hammer for close adapta- 
tion, add clasp to bicuspid and short piece of 14-gauge wire in hole, 
make special tray from plaster model from rough compound impres- 
sion, or fit stock tray to mouth, to tips of incisors only. 

3. Heat compound and apply to tray, take impression in com- 
pound. 

4. Remove impression and trim margin thin, cut out around pin 
and clasp, build up biting block, trim margins thin. 

5. Soften lingual distal, half return to mouth, have patient close 
and swallow, repeat until no further action or muscle or compound, 
gently pressing material toward ridge with wiping finger movement. 

6. Soften lingual mesial half, have patient lick lips, following with 
slight finger pressure against material toward ridge. Repeat till no 
further action. 

7. Soften buccal rim, have patient close firmly and cheek mas- 
sage. Defines masseter muscle, continue till no further action. 

8. Replace cores, clasp and 14 gauge pin, flow thin plaster on 
impression, return to the mouth, have patient hold by closing. Work 
ball of softened compound across labial aspect, front sixes either now 
or with hardened plaster and compound impression subsequently in 
place. Remove and place clasp pins, cores, etc., in impression. 
Pinch thin copper around pin, pour in plaster giving cast with clasp, 
and copper lined hole. Add Roach and Distal rest wires to upper 
with wax, remove, invest and solder. 

9. Cast gold saddles and assemble various parts by solder. 

10. Build down upper to contact, build up lower to ditto, add 
Gysi registering instruments (special horseshoe plate without pin on 
left side), take lateral and condyle tracings. Attach lower to articu- 
lator; from this attach upper, first having removed horseshoe plate, 
etc. 

1 1 . Return both to mouth, cut away upper wax sufficient for 
thickness horseshoe plates, make rotation point tracing. 

12. Grind or stain anterior six, if necessary, set, add bicuspids, 
upper and lower alternately, giving side movements. Add wax to 
upper right crowns articulating with lower porcelain, carve and cast. 

1 3. Vulcanize, return to articulator, correct for interference of 
porcelain and gold, insert and adapt. 

In conclusion, the writer wishes to repeat that one of the problems 
in dentistry to-day is the removable, sanitary, mechanically correct, 
efficient, unobtrusive, non-gingival, margin-irrating restoration of lost 



ORAL HEALTH 



253 



teeth, the construction of which is well within the reach of the aver- 
age and near-average practitioner and his efficient and faithful 
co-worker, the laboratory man, and most important of all, within 
the reach of the great mass of the semi-edentulous public, and that 
when dental science approaches this ideal that the partial denture lo 
be will play no unimportant part as a means towards this happy 
end. 



A Dentist's Hobby. 



By the Editor. 



MOTORING from Toronto to Grimsby during the latter part 
of May, a few acres of land a mile or so west of Grimsby, 
Ontario, in the very heart of the Garden of Canada, caused 
every member of the writer's party to peremptorily demand a dead 
stop. Exclamations of surprise and pleasure were uttered by every 
one, and the road was literally hned on either side with other cars 
containing motorists, who were loath to pass a spot of such surpass- 
ing beauty without a prolonged look. 

Tulips to right. Tulips to left. Tulips everywhere. 60,000 
plants, most of them in wonderful bloom, and of most rare and costly 
variety. There were upwards of 200 varieties, among them being 
about 125 Darwin species, 60 late cottage garden tulips, numerous 
wild botanical types from Central Asia, also a number of rare speci- 
mens of the Parrot family. 

Interest is certainly added to this wonderful collection of tulij)s 



H 






...i' 

> 


wm^^- 




msmr:.' "^^^ 


■^v, 





View of Tulip Display at Summer Home of Dr. Donald 
Clark at Grimsby, Ontario. 



254 ORAL HEALTH 

when it is known that it is all the result of the "pet-hobby" of a prac- 
tising dentist. Dr. Donald Clark. Dr. Clark's office is in the city of 
Hamilton, and he goes back and forth each day, a distance of 16 
miles from office to garden-home, and confidently makes the asser- 
tion that his hobby has not only given abundant pleasure to himself 
and others, but has been the precursor of good health and a "Hfe- 
saver' to him. 

Dr. Clark has been in practice in the city of Hamilton for many 
years, and represents District No. 4 upon the Board of Directors of 
the Royal College of Dental Surgeons of Ontario. 

The following extract, taken from a letter received from Dr. Clark, 
shows the motives that have dominated this most successful horti- 
culturist : 

"I started out with the idea of having flowers grown out-of-doors 
from the time the snow disappears until it comes again, and I think 
that I have succeeded fairly well; in fact, I have a liking for decor- 
ating my Christmas dinner table with flowers picked out of doors on 
Christmas morning, usually from under the snow. Remember, they 
are real flowers of the most delicate possible structure. To get bloom 
the season through you must grow bulbs and perennials as well as 
annuals. This all requires a large amount of study as to the habits 
of growth as well as season of blooms of the different species. Their 
name is legion, especially when it comes to varieties. Another very 
interesting thing is planning to prolong the season of any particular 
type by procuring very early, early, mid-season and late varieties. 
This is particularly easy with such flowers as narcissus, tulip, peony 
and iris, and as for roses you should have them from June till hard 
frost. Another thing that has to be studied very carefully is their 
diseases and insect enemies, with a cure for each. You must also be 
prepared for many disappointments. 

"To come back to tulips, I may say I started in a very modest 
way in the autumn of 1909 with about 275 or 300 bulbs, or five each 
of about 55 or 60 varieties. You have seen what I now have — 
60,000 bulbs and over 200 varieties. These are all late varieties, 
comprising Darwins and Cottage Gardens, also Biggars, Parrots 
and Rembrandts, and several Botanical or wild species from Central 
Asia, which are most interesting. The color embraces everything 
imaginable between black and white. In height, from miniature 
Botanical specimens to Darwins, 35 inches high. I am doing this 
work because I love it, and because I know of nothing better for any 
man, both physically and morally." 

This floral display can be compared to nothing but squares of most 
beautiful carpet — each square of surpassing beauty and each mar- 
vellously blending with its neighbor. In addition to the beauty of 
bloom, the length of stem was exceptional, in many cases measuring 
as much as 35 inches. 



ORAL HEALTH 



255 



Dr. Clark, by patient toil and study, has become an authority on 
tulip bulbs, and now possesses one of the finest and most compre- 
hensive collections to be seen anywhere in Canada between Halifax 
and Vancouver. 

A short time ago Dr. Clark succeeded in obtaining an additional 
5,000 bulbs from Holland, and these have been added to the col- 
lection. With ordinary good luck this mammoth display should 
develop a magnificent bloom next year, and its inspection and study 
next spring will, no doubt, be quite worth while a trip of many miles. 




Talk about a hobby for a dentist. Could a more healthtul or 
more joyous hobby be imagined? Hearty congratulations, Donald. 
You have been really "living" in these past seven years, and have, at 
the same time, been giving unspeakable pleasure to the thousands of 
flower lovers who have had the good fortune to pass along the road 
from Grimsby to Burlington. 

The following extract from the Toronto Telegram is of interest: 

"That Ontario can produce just as fine tulips and just as man\ 
varieties as ever Holland could, was surely proven last night by the 
gorgeous display of the Toronto Horticultural Society in the Odd- 
fellows' Hall on College Street. 

"The exhibits were arranged on small tables in the large audi- 
torium, thus allowing the visitors to get about easily and see each 
exhibit plainly. Of particular note were the tulip displays of Sir 
Edmund Osier and Dr. Donald Clark, of Grimsby. Dr. Clark 
exhibited no less than sixty-five vases, comprising as many varieties 
of the flower. He was awarded a special medal and a certificate to 
the effect that his was the largest and finest display of tulip blooms 
ever shown in the city. Among them were some of the latest devcl- 



256 ORAL HEALTH 

opments in tulip culture from Holland, but which did not in any way 
surpass those produced on his own farm. Some of the striking varie- 
ties were: Retroflexa, resembling a yellow lily; Nora Ware, lilac 
in hue; Elegans Alba, white with narrow red edging; Night and 
Sultan, almost black; and tulips of fawn, coffee, red green and 
brown variegated shades. 



Direct and Indirect Method of Casting Base for Crowns 
on Third Molars or Difficult Teeth.* 



Benjamin L. Brooks, D.D.S., Lynchburg, Va. . 

WITH the advent of the casting machine and oral hygiene and 
prophylaxis, a new dawn broke upon our methods of opera- 
tive procedures. The absolute necessity of perfectly con- 
structed and non-irritating dental work has been emphasized in the 
preservation of sanitation and health in the mouth. A complete 
change of methods has been brought about. Our idea now is to put 
aside all methods that irritate or interfere with the work of nature in 
her efforts to maintain perfect health. This is particularly true in 
artificial substitutes for lost tissue, and especially so in crown and 
bridge work. The old style banded and gold cap crowns have no 
place in modern dentistry. They invariably produce a pathological 
condition of the vital tissues through their impingement upon the gum 
tissues. A perfect fit around the tooth is almost impossible of attain- 
ment. It makes no difference how careful one might be in his tech- 
nique. The banded crown simply means a lodgment of irritating 
substances. Overhanging margins such as these ill-fitting crowns 
produce with their encroachments, and the cement forced down upon 
the soft vascular tissue-forming pockets for the collection of food and 
bacteria, are about the worst things imaginable in the mouth. Such 
methods are directly opposed to the principles of good surgery. We 
dentists do not tolerate such unscientific methods in any other form 
of work. If our fillings and other restorations were left in such con- 
dition we would be branded as a quack and counted as being care- 
less and inefficient. 

It IS possible to entirely eliminate these disagreeable features in 
crcwn and bridge work by adoptmg the technique and method herein 
described. Crowns and abutment crowns for bridges on molar teeth, 
even the difficult third molars, can be made of porcelain with gold 
base, perfectly fitting, with almost the same ease and skill as it re- 
quires to make other forms of crowns, which are far from ideal. 

Porcelain is the very best substitute known for the natural tooth in 
mastic ation, and for this feature alone ought to be used wherever 

Socie[v"'RiSSndrVa! ^^"^ ^"""''' convention of the Virginia State Den.ta-l 



ORAL HEALTH 257 

possible. Porcelain lends a charm of refinement to the acme of work- 
manship and skill. It appeals to those who are fastidious and want 
the very best — it looks like the best. It is easily manipulated by fol- 
lowing this technique and method: 

Technique — Direct Method. 

The roots are prepared in the usual manner under aseptic condi- 
tions, filled and sealed to wthm a quarter of an inch of the chamber. 
This ought to be done with practically the entire top of the tooth 
removed. The crown is now cut off flush — with sharp fissure burs, 
coarse stones and extra large rosehead burs (sometimes called vul- 
canite burs) — cut down to just under the free margin of the gum — 
mesio-distally, in long teeth just above — bucco-lingually, depending 
entirely upon the case. Operator must use his judgment as to prophy- 
laxis and to the extent of cutting to simplify the construction and 
secure a space of sufficient thickness for the porcelain tooth. The 
chamber is now prepared by makmg it as near box-shape as condi- 
tions will permit. This will give, in some places, suffic-ent retention 
for a crown with a perfect fitting base. If more retention is required 
pins can be used. The nerve chamber is boxed in the same manner, 
but enlarged to extend well over the canals to be used so as to allow 
the wax impression to grip the pins thoroughly. The canals are now 
reamed to a depth of one-quarter of an inch or more, care being 
taken to ream them in such a way as to leave them parallel. If this 
is not possible on account of extremely diverging roots, the pins can 
be cut off on one side and placed in their position in the canals in 
such a manner that in withdrawing them while attached to the wax 
base, their outer planes will be parallel and slip by the undercuts with 
ease. The pins are allowed to extend high enough above the canals 
in the boxed chamber to engage the wax firmly in taking the impres- 
sion. Befcre finally putting the pins to j)lace and taking impression, 
the prepared tooth should be oiled slightly by using a very small 
amount of white vaseline, and excess wiped off with a jiellet of cotton. 
A piece of Kerr's inlay impression wax, large enough to (ill the 
chamber and cover the surface well, leaving a small bit to be gripped 
with the fingers for easy handling, heated and shoved to place. If 
preferfed, a copper band, slightly larger than the tooth, may be usod 
for impression cup, filled with wax and shoved to place, thoroughly 
chilled and removed. The ccpper band is split and remo\ed, and 
the wax impression trimmed to the proper circumference of the tooth. 
The impression ends with pins invested with inlay investment. For 
the Elgin machine I prefer Standard Compound, two-thirds, and 
S. S. White's *Tryite" one-third, for this purpose. This is allowed 
to harden and trimmed to the margins of the wax. A sprue is 
attached at one side and allowed to rest close on the investment, so 
that the wax base can be carved as thin as possible or necessary. 



258 ORAL HEALTH 

This is the pretty point. The wax base can be trimmed as thin as 
paper, with ease, without distorting or interfering with the fit in the 
least. The whole piece is now invested as an ordinary inlay would 
be and cast, fitted back on the tooth, and impression and bite taken 
with plaster or compound, models run on anatomical articulator, and 
a Goslee, Steele or plain platinum pin vulcanite tooth, with heads of 
pins cut off (backed in the ordinary way), adjusted to occlusion, 
waxed, invested and soldered. 

Technique — Indirect Method. 
The tooth is prepared in the same manner as described for the 
direct method. Pins cut and placed in the same manner. Copper 
band of sufficient size to fit well over the tooth and trimmed so as 
to allow the teeth to come together, when the band is in place over 
the tooth. The prepared tooth is oiled as described in the direct 
method. The copper band is now filled with soft impression com- 
pound or plaster and shoved to place, with pins in position and 
allowed to harden. It is now removed to make sure that it will come 
away perfect and to see that you have a sharp impression. It is then 
replaced on the tooth and an impression and bite taken of both jaws. 
Models are now run, using hard model plaster for the opposing jaw 
and inlay plaster for the crown model and mounted on the articu- 
lator. The impression is now removed, the pins will be in their proper 
positions, with a sharp reproduction of the prepared root ends. The 
pins are cut off if too long above and inlay wax run over them well 
on to the margins; crown backed and fitted as in the direct method. 
The crown is now cut off and mounted, invested and cast. The only 
advantage of this method is its quickness. It is not as accurate as the 
direct method, and I do not recommend it as being as perfect or 
satisfactory as the direct method. 



Proceeding Overseas with the C. A.D.C., Second Draft 



[The folloTDing report of the journey of the C.A.D.C. 
Second Draft, Overseas, has been received by Oral 
Health, by courtesy of Capt. E. A. Grant. The material 
rvas published in a most attractive brochure, which reflects 
great credit upon those who had the ''history'' in' charge. 
— Editor. ] 

AFTER several delays and when hope of ever getting across was 
almost lost, the second draft of the Canadian Army Dental 
Corps to proceed overseas, finally commenced to move. The 
detachment cf 20 officers, 19 sergeants and 20 men, drawn from 
practically every division in Canada, was in charge of Major A. A. 
Smith, who left Ottawa on December 15th, 1915, after turning over 



ORAL HEALTH 259 

the duties of Acting Chief Dental Surgeon to Capt. W. B. Clayton. 

On arrival in Montreal he was met by some of the party and then 
proceeded to St. John. To some of us the twenty-six hours' run on 
the Intercolonial was rather tiresome, but it must have been doubly 
so to those from the far west, especially Capt. Tait, of Victoria, 
B.C., who had to spend seven days on the train. 

At St. John the party was met by a committee of local dentists, 
headed by Capt. Magee, who escorted us to the Royal Hotel and 
did everything possible to make the stay in St. John enjoyable. 

Friday was a busy day. An orderly room was secured and the 
work of organization proceeded rapidly. Capt. Walt was appointed 
adjutant until the detachment reached Folkestone, and Ca{)t. Win- 
nett was the first orderly officer. Each officer was detailed to some 
duty. 

In the evening the officers were tendered a dinner by the St. John 
Dental Society. After the toast to the King, the chairman, Capt. 
Magee, proposed a toast to the C.A.D.C., which was responded to 
by Major Smith and others. An interesting feature was the story 
by Lieut. Wilson, a wounded officer returning to England, of his 
experiences in the trenches and how he was '*moved" out of them 
by a high explosive shell. 

After Capt. Walt had expressed the thanks and appreciation of 
the C.A.D.C. officers for the very enjoyable evening, and the cour- 
tesies and hospitalities extended by the St. John dentists, the meeting 
broke up with "God Save the King" and "Auld Lang Syne." 

There is more than a suspicion that their hospitality did not end 
there, but was continued further into the night, but of this, history 
sayeth not. 

However, we will all have very pleasant recollections of our stay 
in St. John. 

The corps were astir early on the morning of December 18th. and 
by 7.15 a.m. were ready to move off from the Royal Hotel. 1 hev 
presented a businesslike and trim appearance as they marched 
through the fog and the rain to the ferry and thence to the C.P R 
dock. After a short delay, they were marched on board the s s. 
Missanabie, and the rest of the morning was spent in getting settled 
in the various quarters. 

The troops on board, totalling L721 and comprising 23 different 
units, were mostly small reinforcement drafts; Major Cape of the 
3rd Siege Battery being O.C. 1 here was also a i>arty of Jack 1 ars 
on board, returning from gunnery practice in Bermuda. About 8.30 
in the evening, to the accompaniment of cheers and singing from the 
men on deck. Captain Winnett, assisted by the Chief Engineer, 
pulled the lever which started the boat on its journey to Old England. 

Fortunately. Sunday, our first day at sea was fine and warm. 
Divine service was held in the morning and a concert in the evening. 



260 ORAL HEALTH 

Everyone was agreeably surprised by the fine, warm weather of the 
next few days, and the poor sailors were beginning to think that an 
ocean voyage was perhaps, after all, something of a picnic. 

On Monday a dental clinic was opened for the benefit of the 
troops on beard and placed under the supervision of Captain E. D. 
Madden, with two officers detailed each day for duty. Emergency 
work only was undertaken and some urgent cases were relieved. 
But the fact that the clinic was not kept over busy, seemed to prove 
that the dental needs of each draft had been pretty thoroughly 
attended to by the C.A.D.C. in the Canadian concentration camps 
before leaving. 

After the first few days everyone naturally fell into the daily rou- 
tine of life on a troopship. Everything was run in a military manner. 
Each unit issued daily orders and every morning the O.C. and ship's 
captain, accompanied by the orderly officers of the day, made their 
round of inspection. Hours were arranged for each unit for physical 
drill and a daily practice of lifebelt drill was carried out. This was 
at times very amusing and exciting, especially as the ship approached 
the danger zone and there was a possibility of a real danger signal. 
At the signal of two blasts on the ship's siren, followed by the bugles 
sounding the alarm, each man proceeded to his cab:n, tied on his 
lifebelt and then went by the shortest route to a position assigned on 
the deck and fell into line to await further orders. Each man had 
also been given the number of the lifeboat he was to enter, if such a 
contingency should become necessary. After the first practice, this 
drill was carried out with such celerity that only three minutes after 
the first alarm, each man would be in his allotted position. 

A concert by the Jack Tars on board on the night of Tuesday, 
21st, was an event of unique interest to the soldiers. It reminded 
one very much of a school closing concert of our younger days, as 
the singer would often break down in the middle of a song, either 
because he had forgotten the words or the tune was pitched too high, 
and then, not a bit disconcerted, he would start all over again. How- 
ever, this onlv served to add to the enjoyment of the evening, and 
one felt that Major Cape, the chairman, in expressing the thanks of 
the Canadian soldiers to Lieut. Skinard and his men, very aptly 
expressed the sentiments of all when he said we could not forget that 
il was because of the efforts of our brothers the sailors of the British 
Navy, that we were able to travel across in such comfort and security. 
On the morning of Wednesday, 22nd, we ran into cold, rainy 
and stormy weather, which lasted for three days and kept the poor 
sailers between decks. The writer must admit that he was one of 
those who spent most of the time in their bunks, and therefore knows 
very little of what was going on. However, he believes that those 
who were able to be about were not enjoying themselves very much. 
On Christmas Eve we were warned that the ship would enter the 



ORAL HEALTH 261 

danger zone the following morning and that each man should carry 
his lifebelt at all times. 

Christmas morning opened fine and warm, and everyone was astir 
early and up on deck to enjoy what was perhaps the most unique 
Christmas they had ever spent. The fact that they were in mid- 
ocean and the danger zone did not seem to dampen the Christmas 
spirit as the old, old greeting was exchanged. Many dived into 
their trunks and produced odd shaped parcels labeled "Not to be 
opened until Christmas Day." The gifts contained took one's 
thoughts back home where the spirit of Christmas always centres. 

A programme of sports was run off throughout the day on the 
afterdeck. The wrestling and boxing bouts were the principal fea- 
tures. Sergt. Howe, of the C.A.D.C., proved himself to be the 
champion boxer of the ship. 

About 4.30 in the afternoon, everyone was rather startled to hear 
the siren signal, as it was thought that practice drills were over. 
Instantly there was a scamper and in a very short time all were lined 
up on deck in review order (with lifebelts) and peering into the sea, 
wondering what was coming next. After standing there about ten 
minutes, we were dismissed, not at all sorry that it was only a false 
alarm. 

Excellent Christmas dinners were served to all ranks and in the 
evening a splendid concert was given in three cabins in order to 
accommodate all the audience. The committee in charge were em- 
barrassed by the quantity of clever talent on board and had more 
than enough artists to keep all three concerts going t'll midnight. 
The biggest hit of the evening was Lieut. Black, of the 35th Battery, 
and his minstrel troupe, who put on a very amusing hour's enter- 
tainment. 

The most interesting event of the next day (Sunday) was the hr5t 
appearance of our convoy, which came alongside about 10 a in. and 
accompanied us till noon. However, it was wonderful how j^real a 
feeling of relief and confidence was inspired by this little patrol boat, 
which seemed to typify the Navy's watchful care over us. One 
could better enjoy the Christmas hymns which were sung at Divine 
service. 

The afternoon was spent quietly with packing preparations, as 
the boat was expected to dock before morning, and orders were 
issued for reveille at 5.15 and early breakfast. 

However, we were rudely disappo nted the next morning to find 
that, instead of being tied to the pier, the ship was "hove to" in the 
English Channel. During the night a gale had sjirung up which 
prevented the captain from making the narrow entrance to Plymouth 
harbor. Here we had to put up with the worst tossing of the who'e 
trip, as the Channel certainly lived up to its reputation. Each had 



262 



ORAL HEALTH 



his own story to tell of what happened when one big wave struck 
the ship broadside with a thunderous roar and swept right over it. 

About 3.30 in the afternoon, although the gale had not abated, 
was, in fact, even worse, the captain decided to go in. At any rate, 
ii was a very anxious time for all on board, as even a landsman could 
see that it was a very risky undertaking to take a big ship through a 
narrow channel between the rocks with a tremendous gale blowing 
across it. The crowds on the deck heaved a sigh of relief when after 
an hour of hard work and good seamanship, the breakwater was 
passed and the ship dropped anchor for the night. 

The next morning, Tuesday, the 28th, tenders came alongside, 
and after a short sail up the pretty harbor of Plymouth, we landed 
about noon. By 2 p.m. all were aboard a special troop train for 
Folkestone. It was for some their first sight of an English train, with 
its odd compartment carriages. The insignificant little engme, with 
its ridiculous toot-toot, caused a great deal of amusement at first. 
For the first few hours, everyone was busy looking at the beautiful 
scenery of Cornwall and Devon and the crowds of people who came 
from all directions to wave a welcome to the Canadian boys. When 
this was all shut out by the early darkness the boys naturally thought 
of something to eat, and at every station there was a hurried raid on 
the lunch baskets and bun wagons, which never had enough to 
supply the demand, and as the train pulled out of the station the 
boys would give vent to their feelings by sticking their heads out of 
the windows all down the long train and yelling in chorus, "Are we 
hungry? Well, I guess YES." 

On arrival at Folkestone, about midnight, the party was met by 
Colonel Armstrong and Capt. Holmes. The N.C.O.'s and men 
were taken to their quarters on Earles Ave., and the officers were 
billeted at Wampach's Hotel. 

After a few days' leave, no time was lost in getting down o 
work, and the officers were detailed for duty at the various camps, 
as follows: 



Major Smith, C. A. T).C.Hi'iid(iUiirteris, Folkestone 
Capt. A. W. Winnett, Shorm-lilTe Military Hosp'l 
Capt.C.V.W. Marshall, ShornelifTe Military Hos. 
Capt. J. W. Bell. Westcliffe Eye and Bar Hospital 
Capt. .1. E. Wright. Moore's Barraeks Hospital 
Capt C. S. Walt. West Sandling Caniji 
Capt. B. J. Kelly. East Sandling Camp 
Capt. G. H. Bray. Beachborough Hospital 
Capt. .1. K. Morrison. Clivedon Hospital 
Capt. E. S. Tait. Epsom Convalescent Hospital 



Capt. E. D. Madden, St. Martin's Plain 

Capt. J. F. Shute. St. Martin's Plain 

Capt. W. A. Burns, St. Martin's Plain Laboratory 

Capt. E. A. Grant. Bramshott Camp 

Capt. W. A. Sangster. Bramshott Camp 

Capt. L. L. Matehett. Bramshott Camp 

Capt. B. McNeill, Bramshott Camp 

Capt. H. C. Macdonald. Bramshott Camp 

Capt. R. C. H. Staples. Bramshott Camp 

Capt. P. B. McNally. Bramshott Camp 



□II l I D 

J 



THE COMPENDIUM 

This Department is Edited by 
THOMAS COWLING, D.D.S., Toronto 

A SYNOPSIS OF CURRENT LITERATURE RELATING 
TO THE SCIENCE AND PRACTICE OF DENTfSTin 



J 



Perfect Amalgam Fillings. 

RENEWED interest in the old problem of amalgam fillings has 
been aroused by the excellent results obtained by Dr. William 
E. Harper, of Chicago. A detailed account of his methods 
is published in the April issue of Dental Cosmos. 

Dr. Harper does not place dependence upon the amalgam mi- 
crometer as a means of testing the efficiency of amalgams, because, 
in his opinion, such methods do not show the sufficiency of adapta- 
tion of the filling material to the cavity walls — the most important 
feature, perhaps, in any filling material. In place of the micrometer, 
an air-pressure apparatus has been devised by means of which a leaky 
filling, due either to the quality of the alloy or the imperfectness of 
technique in preparing same, may be easily demonstrated. 

Contrary to most heretofore published opinions. Dr. Harjier favors 
a plastic mix rather than a dry one. He finds that such a mix. 
"thoroughly packed into a cavity will set as quickly and as hard as 
a dry mix, and will improve the adaptation." I he requisites for 
perfect amalgam work are, "a thorough mix, extra plasticity in all 
cavities requiring much time to fill, and forcible packing with orderly 
stepping of the plugger to insure thorough and uniform condensa- 
tion." It is pointed out that where perfect adaptation has been 
obtained between the filling material and the cavity walls, no dis- 
coloration of the tooth substance about the filling will take place. 
This statement is of prime importance, in that it removes one of the 
outstanding objections to the use of amalgams. 

The use of proper proportions of alloy and mercury aids materially 
in bringing about satisfactory results; to this end Dr. Harj^er suggests 
the weighing up of a supply of cajisules containing known (juantities 
of alloy and mercury. 1 he amount of each may best be determined 
by following the instructions given by the manufacturer, and then 
modifying the amounts used as experience dictates. 

Owing to the short time during which the "condition of plasticity 



264 ORAL HEALTH 

favorable to adaptation exists, it is best to complete the cavity pre- 
paration, adjust the matrix and select the instruments to be used m 
the operation, before m:x:ng the amalgam. Kneadng of the amal- 
gam mass from t-me to tme during the process of insertxn tends to 
prolong the condition of plasticity. It is extremely important to 
prolong the plastic stage, becauce an amalgam mass, if set upon the 
operating table, will cool, which greatly hastens the setting." 

The mixing of alloy and mercury is done with mortar and pestle 
and kept up for a period of from two to three minutes. Owing to 
the fact that all high grade alloys are difficult to amalgamate, it is 
imperative that sufficient time be given the mixing process to insure 
complete amalgamation. Dr. Harper suggests the use of an ordin- 
ary egg-timer for the purpose of measuring the time taken in this 
procedure. 

After the mass has been well mixed, it is turned out and kneaded 
for from one-half to one minute. Where large cavities are to be 
filled, it is suggested that the excess mercury be not removed when 
kneading, "but allowed to remain in the mass, to be removed only 
as expressed to the surface during the packing. This will insure that 
add'ticnal extra plasticity of the mass which will permit the filling 
of the first half of the cavity without the development of crepitus or 
evidence of setting." 

A detailed account of instruments used, etc,, is given by the author, 
and the reader is referred to the original article for particulars of 
same. 

Emetine vs. Succinimid of Mercury. 

With a view to establishing the relative merits of Emetine and 
Succinimid of Mercury in the treatment of pyorrhea alveolaris, a 
series of experiments were conducted by Ralph P. Lowell, D.D S., 
and Stephen A. Cobb, M.D., both of Sandford, Me. The results 
of their efforts in this direct'cn are- published in May issue of Dental 
Cosmos. 

The methods of administration of these drugs were those gener- 
ally advised for use by dentists, so that the results have peculiar 
interest for us. Some of their findings are rather unique; for in- 
stance, "We feel that pvorrhea alveolaris is due wholly to the neglect 
of the mouth and the alimentary tract, and that the endamoeba buc- 
calis that is found normally in the mouth really exaggerates this con- 
dition by its presence." These investigators find that there is little 
to choose between the merits of the two drugs. Good results were 
obtained, and it is thought that with good care, combined with 
intelligent co-operative efforts on the part of the patient, permanent 
cures might be effected. 

Ionic Medication. 

One of the most promising fields for the use of this method of 



ORAL HEALTH 265 

treatment is in the curing of oral diseases. Strange to say, its use in 
this connection has been very limited. The plea for a greater con- 
sideration of the merits of ionic medication in the treatment of sucii 
ailments as pyorrhea alveolaris, etc., as made by Dr. Ernest Stur 
ridge, of London, Eng., in Dental Cosmos (April) is one that ought 
not to go unheeded. 

Ionic medication is described as "a method of treatment in which 
electrical currents are used to conduct or convey, in a definite direc- 
tion, ions of solutions which are dissociable by the electrolytic action 
of the current. The body contains combinations of chemical sub- 
stances which are soluble in water, and which are good conductors 
of electricity; it is therefore an electrolyte which, when current is 
passed, responds to the electrical laws of decomposition of solutions 
and movements of ions towards definite poles." 

Exper.ments performed upon gum, periodontal tissue and alveolus 
go to show that "ions penetrate a considerable depth into these tissues 
with a very low current strength." Where it is necessary, as so often 
happens in the treatment of dental affections, to clear up diseased 
conditions of the deep tissues about the roots of the teeth, it is mani- 
festly impossible to effect this by the application of antiseptics to the 
superficial tissues. Ionic medication is said to be particularly suitable 
for the treatment of periodontal membrane, cwing to the de{ th to 
which the remedial agents are carried. 

When treating pyorrhea aKeolaris by ths method, an electrode 
is introduced mto the pyorrhea pocket "conveying a solution of some 
salt, which is readily dissociated by the electrolytic action of the 
current; 3 per cent, solution of zinc chloride— from which zinc ions 
are formed — is one of the most effective salts, and a current of 3 to 
15 m.a. provides a dosage of antiseptic ions suffic ent to sterilize the 
parts. By means cf such treatment it is possible to check t!ie dis- 
charge of pus in a very short t me." 

In add.tion to its usefulness in sterilizing the parts, it is claimed 
that this method of ionic medication will, in some cases, bring about 
the formation of new bone about the roo's of much-loosened tooth. 

Dr. Sturridge would have dentists consider carefully this method of 
treatment with a view to avoiding the extract'cn cf teeth cf young 
people because of there being indications of cr o\on looseness from 
pyorrhea. 

Sterilizing the Tooth Brush. 

This is a subject of prime interest, yet is not gi\on iho amount of 
attention that its importance warrants. Hugh W. MacMillan. 
D.D.S., in Dental Sunimary (February), suggests a method for 
efficient sterilization which is at once easy and unique. 

H's method is to sprinkle salt upon the brush after use. 1 ho salt 
becomes dissolved on the wet brush and poiiotrates thoroughly to the 
centres of the tufts of bristles. 1 he brush is then sot aside, and a- 



266 ORAL HEALTH 

the moisture evaporates the salt crystallizes in and about every 
bristle. When required for use, the salt is knocked off or dissolved 
away and the dentifrice applied as ordinarily. This method is cer- 
tainly simple. Is it effective? 

Dental Physics. 

Some time ago it w^as suggested in the columns of this journal that 
a course of instruction be given to dental students in those depart- 
ments of physics in w^hich dentists are particularly interested. Such 
a course is now in process of preparation and will be given to students 
of the Royal College of Dental Surgeons, beginning with next fall 
term, and will no doubt prove of great value. 

The introduction of the X-Ray as an aid in dental diagnostic 
work, as well as the increasing importance and usefulness of ionic 
medication in the treatment of oral diseases, demand that the dentist 
acquire requisite knowledge to equip his office with and know how 
to get best results from modern dental apparatus. The use of the 
X-Ray in dentistry has been the subject of much criticism, sometimes 
of the unfavorable variety. It has, however, demonstrated its worth, 
secured due recognition, and is now permanently established in the 
good graces of the profession. In the last analysis, criticism, pro- 
vided it be honest and unmixed with prejudice, adds to, rather than 
detracts from, the merits of the object of its attacks. So it has been 
with the X-Ray; its most severe critics have been in reality its 
staunchest friends. As an illustration: In the April issue of Dental 
Cosmos, George M. MacKee, M.D. (New York), than whom den- 
tistry has no better friend, in a brief, pointed article entitled "Radio 
Dermatitis Following X-Ray Examinations of the Teeth," while 
recognizing the X-Ray as an important modern dental apparatus, 
cautions against the use of same by those who have not sufficient 
training. Oftentimes we hear, even from professional men, that with 
a few pointers given by the X-Ray salesman, anybody can operate 
the apparatus without danger to self or subject. In other words, the 
opinion is abroad that science has succeeded in producing a fool- 
proof machine. Dr. MacKee is not in agreement with this view. 
He is of the opinion that dentists should realize that in the X-Ray 
"we have a very powerful and dangerous as well as useful agent, 
and in order to avoid injury to himself and patient he must be 
acquainted with the phy^sics and biologic effects of the X-Ray." 

Not infrequently, when urging caution in the use of the X-Ray, 
one is asked to state reasons for same. This is what Dr. MacKee 
has to say about it. "In the last sixteen months I have seen no 
fewer than eight cases of radio dermatitis produced by X-Ray exam- 
mations of the teeth. In all cases I am convinced that the fault lay 
in the technique. Fortunately, not in a single instance was there 
more than an erythema and edema, which lasted for from three weeks 



ORAL HEALTH 267 

to four months. In three cases the eyelashes, eyebrows and a portion 
of the scalp hair fell out, but the hair returned in all but one case. 
This was a little girl where the hair failed to return in the outer half 
of the left eyebrow. An X-Ray erythema is usually considered of 
no moment; but this is a mistake. I have seen a slight erythema of 
the face, an erythema that lasted a week or two, followed, a year 
or two later, by teleangiectasia (dilated vessels) or visible atrophy, 
or both." 

In support of his contention that the dentist should be taught phy- 
sics. Dr. MacKee gives a list of questions such as would likely be 
asked the dentist were he (unfortunate enough) to be a defendant 
in a suit for damages and were being examined for the purpose of 
establishing his efficiency as an operator of the X-Ray. These are 
a few selected from the list: 

'*What is the significance of the parallel spark gap?" 

"What are meant by 'hard,' 'medium' and 'soft' rays?" 

"Explain the purpose of the aluminum filter." 

"Why do you employ the diaphragm?" 

"What degree of quality has the most effect on the skin?" 

"How can quality be controlled?" 

"How can quantity be estimated?" 

"What quantity of a given quality will injure the skin?" 

"Why and how is the interrupterless transformer superior to the 
coil?" 

These are the sort of questions that would be asked of the dentist. 
and his failure to give satisfactory answers would work great harm 
to the interests of his case. A complete course in dental physics 
ought, surely, to cover just such points as are raised by the above 
questions. 

The New Dental Law of New York. 

The amended dental law of the State of New York comes into 
effect on September 1st, 1916, and introduces some features which 
are so radical in character as to be of interest to all dentists, and 
especially those who follow the efforts being i^ut forth in Canada to 
improve the status and safeguard the interests of the profession. 

Among other things, this Act provides for the cancelling of th»" 
license of "any practitioner of dentistry charged under oath before 
the board and found guilty of unprofessional or ignorant conduct, or 
with gross ignorance or inefficiency in his profession, or with fraud or 
deceit in procuring admission to practice." 

Commenting editorially on this provis?on of the new law. Cosmos 
(May) says: "It will not be difficult to show in a given case that 
the operator who permits septic conditions to exist in connection with 
his root-canal work or his restorative operations in general, will be 
guilty of 'gross ignorance and inefficiency in his {profession, and sub- 
ject, therefore, to revocation of his license under the New ^ ork State 



268 ORAL HEALTH 

law — if, indeed, as the result of educated public opinion, he will not 
also be answerable for criminal malpractice.' " This looks like strong 
medicine, but perhaps the profession is suffering from ailments of a 
kind that require severe methods of treatment. 

The inauguration of suc^ legislation brings dental teachers of 
Canada face to face with a serious problem. Do our students re- 
ceive sufficient training in root-canal filling to enable them to face 
fearlessly the enactments of a law such as the New York State law? 
If not, then our schools are responsible! Of the total college term 
only a few months are spent by the student in the infirmary, and only a 
portion of this time is spent in the treatment of root-canals. Conse- 
quently the student has little opportunity for observing the results of 
his methods of treatment. 

In addition to establishing the liability of the dentist for unpro- 
fessional practice, the law deals with the legalizing of the "dental 
hygienist" or dental nurse. The time seems opportune for a more 
general discussion of this question. Its serious import demands 
attention. 

Treatment of Ulcero-Membranous Stomatitis. 

A paper on the above subject appears in the April issue of the 
British Journal of Dental Science, and contains much information 
calculated to facilitate the treatment of inflammatory mouth condi- 
tions. This art'cle holds particular interest for us, in that it is written 
by F. B. Bowman, M.B. (Toronto), Pathologist, Moore Barracks, 
Canadian Military Hospital, Shorncliffe. 

Dr. Bowman, on examination of soldiers returned from the front, 
found, in addition to pyorrhea alveolaris, a peculiar condition "upon 
the gums (partxularly around the last molars), the tongue, mucous 
surfaces of the cheeks, and the tonsils (which are most frequently 
affected), ulcers. These ulcers tend to spread laterally, save in the 
tonsils, where they burrow deeply into the tissues. They are covered 
by a white, friable membrane, easily removed, and then leaving a 
bleeding surface beneath." 

"The condition of the mouth in advanced cases strongly suggests 
scurvy. The gums bleed easily, are injected, retracted from the 
teeth, and spongy-looking. The teeth are apt to become loose, and 
are often tender when tapped with a metallic instrument. The 
breath is fetid and patients complain of a foul taste. There is 
always more or less glandular enlargement, the submaxillary and 
sublingual glands being most often affected." 

Dr. Bowman gives due recognition to such agent as emetine, etc., 
in the treatment of such conditions, but found that most satisfactory 
results were obtained by administering a combination of ipecacuanha 
or its alkaloid and Fowler's solution. The following treatment gave 
"remarkably rapid and favorable results": 



ORAL HEALTH 269 

[^ Vinum ipecacuanhac "^ ss 
Glycerinum 5 i 
Liquor arsenicalis ad — ^ i 
M. : fiat mish. Sig: To be used as a mouth wash; do not 
swallow. 

Label "Poison." 
"When the gums only are affected this solution can be carefully 
applied to the gum pockets around the teeth. Where there is ulcera- 
tion elsewhere in the mouth or throat, the ulcer should be thoroughly 
wiped out twice every day with the above solution. All patients, 
whether or not the gums be infected, are instructed to drop ten to 
fifteen drops of the mixture on to a tooth brush twice a day and 
brush the teeth and gums vigorously." 

With this treatment the condition clears up quickly: the ulcers 
heal, the fetid breath disappears, and the patient is soon able to eat 
in comfort, 

Demonstrating Blow Torch Method of Cast and 

Solder Work.* 



Dr. William Page Williams, Brookneal. Va. 



IN this clinic a compact portable outfit was shown, which appeals 
especially to the village and country dentist. 
Dr. Williams used a Turner double-jet blow-torch for all of 
his casting and soldering, and in his own practice this kind of work 
is all done on the leaf of a roller-top desk just back of his chair, 
several asbestos mats being kept in a drawer beneath for this 
purpose. 

The blow-torch, to which is attached a pressure indicator, is 
filled about three-fourths full of gasolene and pumped to about 
twenty pounds pressure, and while it may be turned low and kept 
blowing for a number of hours for waxing, light soldering, etc.. 
without any great decrease of pressure, with a slight turn it may be 
brought to an intense flame for heavy soldering and casting. Cjold 
is very quickly brought to the boiling point, with little liability of 
injury to the investment in casting. 

Dr. Williams used a plunger with white plastic clay for casting 
gold in S.S.W. casting rings. This plunger was held in the left 
hand, while the blow-torch is changed to any desired angle in the 
right hand. This little outfit will accomplish any soldering and 
casting operation that is encountered by the deiiti.st. while it does 
away with the worry of the cumbersome foot-bellows, rubber tubing, 
and the too frequent need of heating u|i the gasolene generator in 
cold weather. 



*Clinic. Vir.uini.i State Dentnl So»Moty. Rirhmoiul. N.n.inl..T. r.«l... 



D 



MULTUM IN PARVO 

This Department is Edited by 
C. A. KENNEDY, D.D.S., 2 College Street, Toronto 

HEIPFLIL PRACTICAL SUGGESTIONS FOR PUBLICATION, SENT IN BY MEM- 
BERS OF THE PROFESSION. WILL BE APPRECIATED BY THIS DEPARTMENT 



D 



D 



n 



Removing Tin Foil From Vulcanite Plates. — Small par- 
ticles of tin foil adhering to vulcanite plates can be easily removed by 
mixing mercury with enough alloy to keep it from flowing, and rub- 
bing this mixture over the plate. — Pacific Dental Gazette (Dental 
Cosmos). 

Tightening the Lid of a Vulcanizer. — The rubber ring of 
the vulcanizer is sprinkled with powdered meerschaum, the lid re- 
placed, and the screw tightened, at first lightly, then more firmly as 
the boiling point is reached. — Zahnaerztliche Rundschau (Dental 
Cosmos). 

Cleansing a Fountain Spittoon. — From time to time the 
interior of the bowl of the fountain cuspidor becomes coated with 
deposits from the water. This coating is readily removed by very 
dilute nitric acid, which quickly dissolves the hard coating without 
the slightest damage to the bowl. — 5. M. My^ers, Texas Dental 
Journal (Dental Cosmos). 

Impingeing Inlays. — In fitting gold inlays to cavity where there 
are intricate conditions or surfaces, heat inlays to redness (provided 
they are 22-carat gold). This will oxide them so that any impinge- 
ing surfaces can be readily seen and corrected. — C. E. Allshouse, 
Chicago, III. (Denial Review). 

Making Wax Model For An Inlay. — To make certain that 
wax has been forced to all parts of a cavity, a thin copper band, 
loosely fitted about tooth, should be used in each case. It confines 
the pressure, and pressure causes a density of wax, so necessary for 
definite gold castings. — W. D. N. Moore, Chicago, III. (Dental 
Review). 

Taking Impressions in Persons Who Have Worn Plates 
Before. — It has been observed that after a person has worn a plate, 
especially one of vulcanite, for some time, the mucous membrane 
swells slightly. Tliis is the reason why new plates often do not fit 
satisfactorily. As the mucous membrane returns to normal condition 
within about twenty-four hours, if no plate is worn, the patient should 
be requested to go without a plate for that length of time before a 
new impression is taken. — La Odontologia Colomhiana (Dental 
Record). 



J ORAL HEALTH 



EDITOR 

WALLACE SECCOMBE, D.D.S., Toronto, Ont. 

CONTRIBUTING EDITORS 

GEORGE K. THOMSON, D.D.S., Halifax, N.S. 
F. W. BARBOUR, D.D.S., Fredericton, N.B. 
ASHLEY W. LINDSAY, D.D.S., Chengtu Sze Chuan 
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y. 
T. W. WIDDOWSON, L.D.S., London, England. 
J. E. BLACK, D.D.S., Vancouver, B.C. 
MANLY BOWLES, D.D.S., Winnipeg, Man. 
J. A. C. HOGGAN, D.D.S., Richmond, Va. 
EDGAR D. COOLIDGE, D.D.S., Chicago, III. 
RICHARD G. Mclaughlin, D.D.S., Toronto. 



Entered as Second-class Matter at the Post Office, Toronto. Sub- 
scription Price: Canada, $1.00; Other Countries, $1.25; Single Copies, 23c. 

Original Communications, Book Reviews, Exchanges, Society Reports, 
Personal Items and other Correspondence should be addressed to the 
Editor, Oral Health, 269 College St., Toronto. Canada. 

Subscriptions and all business communications should be addressed 
to The Publishers, Oral Health, 269 College St., Toronto, Canada. 



Vol. VI. 



TORONTO, JUNE, 1916 



No. () 



H 



E I) I T O R.I ALi 



H 



Hygiene and Dentistry. 



IT is a strange circumstance that for so many years scientific men 
have persistently disassociated disease of the oral cavity from that 

of the other parts. No doubt the early organization of dentistry 
as a separate profession has been responsible, in a large measure, for 
this condition. The administration of dentistry as a separate and 
distinct unit has not, however, in any way changed the micro-organ- 
ism or its human habitat, and "disease" has remained "disease," 
whether the part affected was the oral cavity or some other part of 
the body. 

It is to be hoped that the dental profession will not now iiiakr a 
somewhat similar mistake in failing to recogni/e the dehn'te relation- 
ship between the problems of individual hygiene and modern dental 
conditions. Questions of air, food, digestion, exercise, and all other 
hygienic problems relate to dentistry just as much as they do to medi- 
cine. In fact, these problems are in part the problems of the den- 
tistry of the future, and must be given most thoughtful study in then 
relation to the cause and prevention of dental disease. 

It is reported that a dental infirmary has been established in New 



272 ORAL HEALTH 

York for the dental treatment of poodle dogs. Dogs do not ordin- 
arily contract dental disease, but when brought under the baneful 
influence of modern civilization and allowed to live, sleep and eat as 
do modern humans, dental decay results. What a commentary upon 
our boasted civilization? Statistics show that diseases of the diges- 
tive tract are markedly upon the increase. Dental diseases are prop- 
erly included in this classification. There is undoubtedly a direct 
relationship between modern habits of living and consequent disturb- 
ances of the digestive tract and the increasing prevalence of dental 
disease. 

To-day is a day of great opportunity in dentistry. The future lies 
before and is richer in possibility for scentific advancement and human 
iicrvice than any of the days that have gone. Prevention must occupy 
a place of growing importance in the thought of every dental prac- 
titioner who desires to render the highest and best possible service to 
his patient and humanity. 



Western Canada Dental Society. 



THE Western Canada Dental Society will hold its Annual Con- 
vention in Regina on June 26th, 27th and 28th, 1916. A large 
attendance is expected, as some of the best known men in den- 
tistry will give both papers and clinics. The manufacturers' exhibit 
is to be a big feature of the convention. — M. R. Parkin, D.D.S., 
Regina, Secretary, W.C.D.S. 



De ital Operations. 



Performed by Officers of the Canadian Army Dental 

Corps, in England and Overseas, July 15, 1915, 

TO March 31, 1916. 



Headquarters, C.A.D.C., 23 Earls Ave., Folkstone, April 9, 1916. 

Frllingis. Treats. Dents. Prophys. Ext. 33evit. Total. 

July, 15 officers 1,856 576 lit) 11-3 1,370 478 4,512 

August, 31 officers ... 5,875 767 509 604 4,613 988 13,356 

September. 38 officers. 7,150 1,507 845 1,154 6,069 1,020 17,745 

October, 42 officers ... 9,890 1.903 1,250 1,040 6,695 1,199 21,977 

November, 42 officers. 10,759 2,621 1,351 1,066 6,995 1.546 24,338 

December, 38 officers. 8,837 1,935 1,287 728 5,336 1,423 19,546 

January, 61 officers ... 13,559 2,159 1,803 1,780 9,526 1,756 30,583 

February. 61 officers . 13,263 1,842 1,686 2,000 10,371 1,454 30,616 

■■\March, 64 officers ... 15,698 1,994 2,048 2,225 15,104 1,868 38,937 



Total 86,887 15,304 10,898 10,710 66,079 11,732 201,610 

*Re]port,s in full for :March have not been received from the Dental Officers 
wi.th the British :Mediterranean Expeditionary Force and four officers in France. 

J. Alex. Armstrong, Lt-CoL, 
Director of Dental Services, Canadian Continsrents. 



Dr. C. H. Gerrish, ELxeter, N. H. 

Who Has Practised Dentistry For Over Fifty 
Years, States the Follorving to be 

His Creed 

IF Cleanliness is next to Godliness 
(Goodness) then begin and end the 
DAY WITH A Prayer, followed by a 
Thorough Cleansing of the Mouth 
AND Teeth, thus rendering yourself 
Immune from Deceit and Decay, the 
Devil and Disease — for a Clean Soui- 
AND A Clean Mouth are much to be 

DESIRED. 





The Late Major P. P. Ballachey 

Second in Command 58th Bait, 

Died a Hero in Active Service 

Flanders, June, 1916. 



m 



^iia 



m 



OPAL HEALTA 

A JOURNAL THAT STANDS FOR THE '* OUNCE OF 
PREVENTION," AS WELL AS THE "POUND OF CURE" 



D 



VOL. 6 



TOKONTO, JULY, 1916 



No. 7 



Dental Hygienists. 

R. J. Reade, M.A., D.D.S., M.D.C M , Toronto, Canada. 



[Editorial Note. — Dont fail to read this article. The 
question of the dental nurse is one of the most important 
problems confronting the dental profession to-da\j. Dr. 
Reade has referred to a number of important matters }vhich 
should be carefully^ considered before the profession is fur- 
ther committed to the so-called ''oral h^gienist.''] 
THE cral hygiene movement, which in the jiast few years has 
been carried on so vigorously, has resulted in the awakening of 
the medical profession and the laity to such an extent that there 
has arisen a great demand for dental treatment. I he demand has 
been made a pretext for introducing the dental hygienist or nurse. 
The New York Legislature has passed a bill dealing with the (}ues- 
tion of dental nurses. In part, the bill reads as follows: "Any diMital 
dispensary or infirmary, legally incorporated and registered by the 
regents, and maintaining a proper standard and equipment, may 
establish for women students a course of study in oral hygiene." 

The thought that immediately presents itself is: Why confine the 
license to women, should men not have an equal right to perform the 
same kind of work? 

The object of introducing the dental nurse, is to overtake the work 
caused by the great demand for dental service, brought about by the 
oral hygiene campaign. How far is this legislation regarding the 
dental nurse going to help the case? Ihe bill says: "Such dental 
hygienists may remove lime deposits, accretions and .-^tains from the 
exposed surfaces of the teeth, but shall not perform any other opera- 



27b ORALHEALTH 

tion on the teeth or tissues of the mouth." Very Httle is the case Hkely 
to be helped, for the great need is to get the teeth filled. If the 
sphere of action of the dental nurse is limited to the removal of 
accretions on the teeth, then the licensed dental nurse is introduced, 
and yet practically no means gained to do the enormous amount of 
work needed. 

Why limit the nurse to cleaning teeth? Cleaning teeth is a vague 
expression. Who shall say w^here the act of cleansing ends, and 
where the operation for the treatment of pyorrhea begins? The 
skill of the dental nurse must be great, or the injury to the patient 
irremediable. The removal of accretions from the teeth is one of the 
most important operations in dentistry, requiring the greatest skill to 
avoid injuring those delicate tissues, the destruction of which means 
the loss of teeth. There would be far less chance of doing injury to 
the patients if the nurses, instead of cleansing the teeth, were to per- 
form other dental operations, for instance, to take impressions of the 
mouth. The worst that would probably happen would be a failure 
to get the impression. 

It would require little education of a capable nurse to enable her 
to get a wax model of an inlay from a properly prepared cavity. In 
general surgery nurses change the dressings of wounds. Surely a 
dental nurse could change dressings in the roots of teeth. 

Where will all this end? Artificial distinction can be maintained 
only so long as the power remains in control of those interested. But 
let some leader arise who knows the conditions that obtain, and who 
will comprehend that if the dental nurse can be trained in so short a 
time to perform one of the most important operations in dentistry, it 
would appear to be only the law that keeps the public from receiving 
more abundantly the benefits of dental science. The people will 
demand that the barriers be broken down, and that the benefits of 
dentistry be not withheld from them, because of legislation in favor 
of the dentists. 

This new legislation of the nurse is leading to this end. Because 
there is too much work to do, the dental authorities in New York are 
seeking to get assistance to help the work. When the Government 
and the people see that there are not sufficient dentists to do the work, 
then the demand will be made for more. How will this demand for 
more be reconciled with the demand of the profession to raise the 
standard of dental education from three to four years? 

Let the dental profession once acknowledge that one year will 
prepare the dental nurse for the important work of removing tartar 
and stain from the teeth, then it will not be difficult to prove to the 
Government that a two years' course would amply prepare a man 
for extracting teeth, making plates, filling root canals, preparing cavi- 
ties and inserting inlays and fillings. The Government will say the 
need is so great that we should not give so much time to such subjects 



ORAL HEALTH 277 

as physiology, anatomy of the arms and feet, bacteriology, micro- 
scopy, etc. And is there some force in such an argument? It is the 
logical outcome following the introduction of the dental hygienist. 

But what would the result be? A lowering of the dental standard. 
Then which from the standpoint of dental profession is more desir- 
able, the elevation of the dental standard, or the introduction of the 
licensed dental hygienists? 

If it were possible to stop with the defined duties of the hygienist, 
the result would not be so dangerous. But it is hard to conceive how 
such a limitation could be logically maintained in the face of the 
enormous amount of work waiting to be done. 

We would tend toward the condition of affairs as now obtains in 
England. In England the law protects all those who practise den- 
tistry without a license, provided they do not use the title of dentist, 
or some such designation, to deceive the public. So far as any one 
is able to render satisfactory dental service the law protects them, 
and allows them to give their services, and receive payment for the 
same. The authorities claim that the poorer part of the population 
should be able to have their teeth attended to. This they would not 
be able to do if only the registered dentists were practising. Further 
than this, it is claimed that for the practise of dentistry no such great 
preparation is necessary as is claimed by the dental authorities. 
Therefore, if an individual desires to practise dentistry he may do so, 
but at the same time he is liable for suits of malpractice. 

In the State of Massachusetts there is an act relative to the regis- 
tration of the dental nurse. The nurse may be either a man or a 
woman. First, we notice that any public or charitable institution 
may employ any number of nurses. Next, note the operations that 
may be performed by the dental nurse. First, the examination, what- 
ever that means and includes. Second, cleansing. What a loose 
expression this is. It is so vague that it may strike at the root of the 
science of dentistry. 

Registered dental nurses shall be licensed to perform only such 
duties as shall be specified in his or her license, and solely under or 
by the direction of a registered dentist. No dental nurse sh.ill be 
licensed to perform any services other than the examination, cleansing, 
wedging, and taking modelling compound or wax impressions of 
teeth, inserting and changing dressings in teeth for the relief of pain. 
and assisting a registered dentist during the [performance of his dental 
operations. 

Whatever else may be said, this is certainly giving to the nurse a 
credit for a knowledge that applies to the medical side of dentistry. 

It would be small wonder if a Government would protect a pro- 
fession that admitted the fact that a dental nurse with little education, 
compared with that required by the dental student, could perform the 
most important operations in dentistry, namely, make intelligent exam- 



27» ORAL HEALTH 

inations, cleanse the teeth, and treat them to relieve pain. 

Without a license, an assistant makes crowns, inlays, dentures. 
What difficulty would there be in getting on w'thcut the dentist when 
we have the dental nurse and the laboratory man? There would be 
no difficulty if the nurse could do what the Act allows. 

Again the Act reads: "No dentist shall have at one time more 
than one registered dental nurse in his employment." It would be 
very hard for a layman to understand such a provision. If the nurses 
are able to do the work, why limit the number employed; if they are 
not able to do what is required, why allow them to operate on the 
patient ? 

We are daily learning of the great increase in the demand for 
dental work. It is reported that in a certain school section the trus- 
tees were considering the medical and dental inspection of the school 
children. The dentists were not enthusiastic. This astonished the 
trustees, and they pointed out to the dentists that if the trustees carried 
out the plan that hundreds of children would be sent to the dental 
offices, ready to get work done at reasonable fees. To the astonish- 
ment cf the Board, the dentists replied that they were not anxious for 
that sort of work, and that they worked for children as little as 
possible. 

If the profession does not care for this work, what is to be done? 
What is the solution of the difficulty? Will the dental nurse solve 
the problem? She would only be allowed to cleanse the teeth, but 
that would not fill the children's teeth. Shall people be allowed to 
practise dentistry without a license, as in some countries? Or would 
a two or three-year course be the wisest plan to adopt? It, at all 
events, would be better than an indiscriminate practise of dentistry. 



Employees of Canadian Dental Supply Depots Serving 
with His Majesty's Forces. 

Claudius Ash & Sons — 

R. C. Windeyer, Lt.-Col., Headquarters Staff. 

W. J. Kempthorne, Brigade Major, 1 5th Brigade. 

W. T Bleakley, Major, 126th Batt., C.E.F. 

Duncan Pollock, Sergeant, Canadian Army Dental Corps. 

W. Windeyer, Major, 234th Batt., C.E.F. 
Goldsmith Smelting & Refining Co. — 

P. N. Alexander, Lieutenant, 2nd Batt. 

J. Price, Sergeant, 198th Battalion. 
Leighton-Jagkes Mfg. Co. — 

R. Wallis, Private, Ammunition Park. 

Colon Sinclair, Private, 48th Highlanders, Prisoner in Germany. 

Evan Luno, Lieutenant, 2nd Canadian Mounted Rifles. 



** Gassing" and Its Effect on the Oral Tissues/ 
Captain J. G. Roberts, C.A.D.C. 



I WISH to acknowledge publicly that I am permitted to address 
you on this occasion by the courtesy of my superior officers. Cap- 
tain W. G. Thompson, Officer Commanding Dental Services, 
Military District No. 2, and Major W. B. Clayton, Officer Com- 
manding Dental Services, Headquarters, Ottawa. 

Much has been said and many articles have been written in refer- 
ence to the surgical restorations that have been made and the won- 
derful results following the different methods of treatment given our 
soldiers at the front and in the different hospitals in the mother land, 
but sir, I believe this is the first occasion on this continent in which a 
bcdy of professional men has been brought face to face with the 
question of "Gassing" and its effect on the oral tissues. 

I have been requested by your president to prepare a short paper 
and give an account of the oral lesions that have come under my 
observation. In doing so, I state with pleasure that manv members 
of the medical profession fully realize the importance of having the 
mouth and its tissues in a healthy condition. 

For your information, I may state the cases I have treated are 
principally from the first battalions sent overseas from Canada, viz: 
1st, 2nd, 3rd, 4th, 5th Canadian Mounted Rifles, G.G.B.G., and 
last, but by no means the least, "The Princess Patricia's Canadian 
Light Infantry." 

For convenience, I shall divide the cases that have come under my 
notice into two classes: 

1st. Those persons who had given little or no attention to the oral 
cavity before enlistment. I may be permitted to point out that the 
professional men who examined these soldiers appear to have given 
little attention to the mouths of these men. Apparently they did not 
realize the baneful effects of septic absorption, juirticularly in men 
who were about to engage in a strenuous life where all their energies 
were about tc be brought into active service. 

2nd. Those men whose mouths had been given careful treatment 
before enlistment. 

The local symptoms in persons who have been "gaseed" are usually 
pronounced and are readily distinguished. 

In the first class, "where no attention has been given." we find 
decayed teeth, abj:cessed roots, deposits around the necks and extend- 
ing under the gum margins. Ihese deposits vary in color from an 
almost black shade to a dark brown. Around the necks of the teeth 
pus exudes in varying quantities. The gums are highly vascular, and 



Torontd. Juno 2. lOlfi. 



280 ORAL HEALTH 

are shaded from a deep purple to a bright scarlet. They are usually 
extremely sensitive to the touch and bleed freely with the slightest 
pressure. Many of these soldiers report that the soft tissues were so 
sensitive in a few days after being "gassed" that they were unable 
to eat any solid food and were forced to take tepid drinks only. 

In the second class, "those whose mouths were in a healthy condi- 
tion at the date of enlistment," there are usually deposits, in many 
cases, with pus exuding. The local inflammation seems much more 
acute. The bleeding is more profuse, and the tissues markedly sen- 
sitive. On account of pain little or no attention has been given to 
the teeth and gums after these men were gassed, hence the processes 
of inflammation and absorption work along ^^•ithout interruption. I 
desire to call your attention to the baneful constitutional effects of 
this septic condition. The same constitutional effects are produced 
whether these are taken into the stomach by the alimentary canal, or 
are absorbed into the circulation directly. 

Many of you have seen cases of arthritis, myelitis, and disordered 
action of the heart. I refer you to that admirable paper by Dr. 
W estcn A. Price, of Cleveland, read at the annual meeting of the 
Canadian Oral Prophylactic Association, Toronto, February 1 4, 
1916. By a careful perusal of this very valuable and scientific con- 
tribution much information may be gained and the importance of 
septic absorption may be understood. 

Many cases have tubercular lesions, some with T. B. family his- 
tory, others having contracted since enlisting. The principal differ- 
ence is a slower bleeding, but more continued. One very marked 
symptom in almost all of the cases I have seen is the extreme nervous 
condition of the patients. This may be attributed to the heavy work 
of the campaign, the great shock to their systems, the vast amount of 
nervous energy and physical force consumed while in action, and I 
believe, in many cases, the greatest of all, septic absorption. Some 
patients are so unstrung that it is \N'ith difficulty a glass of water is 
raised to the mouth. 

The course of treatment is similar for all the different classes I 
have enumerated, viz: The ccmplete removal of all roots and teeth 
that cannot be restored to a healthy condition. The thorough and 
gentle removal of all deposits, rough surfaces whether on teeth or 
loots. The breaking up and obliteration of all placques. etc. All 
necessary fillings should be inserted as scon as the condition of the 
mouth warrants. 

The soft tissues respond to careful treatment of warm, mild anti- 
septic and normal saline solutions. 

Those solutions with a glycerine base appear to have the greatest 
soothing effect, particularly when used in a very weak solution and 
as hot as can be borne. 

Several treatments are necessary, particularly when abscessed roots 



ORAL HEALTH 281 

have been removed, and also where the inflammation is most marked. 
Many of these soldiers have badly coated tongues, fetid breath, etc., 
due in many cases to the poison absorbed and to constipation. 

Beneficial results are obtained in T. B. cases by an extra dose of 
oil. In ordinary cases magnesium sulphate in a small dose with a 
copious draught of water. The local treatment should be strictly 
palliative. After a time, when conditions warrant, gentle massaging 
of the soft tissues is beneficial. 

Most of you are aware of the disastrous effects of "gassing" on 
lung tissue, and of the difficulties that are met with in treating such 
cases successfully. I may point out the probability of having to treat 
cases new to us when our soldiers return from the battle fields of 
Southern Europe, Asia and Africa. It surely behooves all thinking 
professional men to be alert at this period in our history. I do not 
believe it is a question of monetary remuneration that prompts us in 
our different tasks, but a higher and nobler purpose of rendering our 
intelligent services to the best manhood of cur land, who are offering 
their lives on the altar of sacrifice that the principles we hold dearest 
may prevail: Our faith and loyalty to the British Constitution, the 
defence of the weak, the respect for the honor and virtue of woman- 
hood, and those grand Christian principles laid down for our guid- 
ance by Almighty God. 

If we are true to these principles, surely we should give our best 
efforts and thoughts to these men who have gone forth, fought, bled 
and suffered for us that our honor may be preserved and the sanctity 
of our homes secured. We shall then have the satisfaction of having 
done our manly duty, and one reward will be, "Inasmuch as ye have 
done it unto one of these, the least of my creatures, ye have done it 
unto me." 



Hospital Patient Refused Dental Treatment. 



DR. J. A. BOTHWELL, in charge of Dental Services. Toronto 
General Hospital, reports that a ward patient, suffering from 
stomach trouble, was recently j:)cremi)torily discharged from 
the hospital because of refusal to allow the hospital dentist to put his 
mouth and teeth in a condition of health. 



To Place a Cement Filling. — When I place a cement filhng 
I dip the plastic instrument in alcohol, shake off excess and proceed 
to place the filling, which overcomes the difficulty of having the cement 
cling to the instrument. Is this not better than using grease on the 
instrument, which becomes incorporated m the filling material to its 
detriment?— £JiPar J D. Ralph, D.D.5.. Dental Digest (British 
Dental Journal). 



Horticulture — A Hobby for the Dentist. 

Dr. Frank E. Bennett, of St. Thomas, Renders Important 

Public Service. 

[Last month Oral HEALTH published an illustrated 
account of the wonderful garden success of Dr. Donald 
Clark, of Hamilton. In this issue the splendid results of 
Dr. Bennett's efforts in connection with the St. Thomas 
Horticultural Society are described. The work of D:. 
Bennett in Horticulture is good citizenship of a ty^pe 
worthy of emulation by many other members of the dental 
profession.] 

IN many local Horticultural Societies the chief benefit accrues to 
the individual member of the society, but some years ago Dr. 

Frank Bennett, of St. Thomas, conceived the idea of making the 
St. Thomas Horticultural Society a bigger and better society than it 
had ever been before, by securing an annual appropriat'on for the 
laying out and maintenance of a number of boulevard flower beds 
throughout the city. The citizens of St. Thomas have appreciated 
this effort, and the membership of the Horticultural Society has in- 
creased from one hundred and twenty-seven to fourteen hundred, 
and the number of public flower beds has increased in like propor- 
tion. 

Membership in the St. Thomas Horticultural Society has come to 
mean something more than the mere payment of an annual fee. The 
members are able to secure bulbs, shrubs, roses, etc., practically at 
cost. The increased buying power of the society has become a large 
factor in its success. Orders are sent direct to the growers for ship- 
ments in carload lots. Last fall 125,000 bulbs alone were purchased, 
besides palms, ancubus, boxwoods, etc. This spring over 4,000 
roses, 1,000 shrubs, 20,000 gladiolii and 500 peonies were dis- 
tributed and sold among the members. The repetition of th's effort 
each year will soon establish St. Thomas as the recogn'zed "Flower 
City" of Canada. 

Dr. Bennett, the President of the Society, and his co-workers have 
made frequent pilgrimages to Rochester, N.Y., for ideas and sug- 
gestions, and it is planned to model Pinafore Park, St. Thomas, after 
Rochester's famous Highland Park. Pinafore Park already con- 
tains a collection of sixty varieties of Hlacs, 150 varieties of peonies, 
1 00 varieties of hardy phlox, 1 25 varieties of dahlias, 1 50 varieties 
of iris, splendid collections of Japanese maples, narcissi, lillies, roses, 
delphinium, rare trees and shrubbery, all donated by the Horticul- 
tural Society to help put St. Thcmas on the "flower map" and make 
her "somebody." 




A Section of the Tulip Exhibit of the St. Thomas Horticuhural Society Show 



Dr. Bennett is enthusiastic in his work as President of the Horti- 
cultural Society, frequently being up at five o'clock in the morning 
arranging the work of the men in planting out the flowers. With 
one hundred and sixty boulevard beds throughout the city, the work 
of planning, planting and maintenance is no light task. 7 here will 
be planted this year in these beds about 8,000 geraniums, cannas, 
salvias, etc. 

The plans being worked out for the citizens of St. Thomas along 
this line lead the whole Dominion, and it should give the dental pro- 
fession a great deal of pleasure to know that one of their own num- 
ber has been the moving spirit in this enterprise. 

Dr. Bennett was born in St. Thomas and has always taken a 
prominent part in its public activities. He has, for many years, been 
a member of the Board of Education, having been chairman of the 
board in 1915 and of the buildings and grounds committee in 1916. 
This, no doubt, accounts for the fact that the school grounds of St. 
Thomas are noted for their beautiful lawns and flowers. Dr. Ben- 
nett attaches great importance to the creating of a |)roper environ- 
ment for the citizens of a community, and by surrounding the boys 
and girls with an abundance cf flowers and training them in their 
appreciation and care, hoi)es that these influences will reflect them- 
selves in a better type of citizen as the years go by. 

St. Thomas specializes en the tulip, of wiiich o\er two hundred 
varieties are planted in the gardens and en the streets of the city. 
The horticultural beds alone contain 25.000 bulbs of innumerable 
varieties. A conservative estimate would be ever one-quarter of »i 
million bulbs in the city and the work has only begun. One hundred 
and eighty-seven varieties were planted this spring, and at the early 
spring show the society exhibited sixty-five varieties, and at the Dar- 



284 ORAL HEALTH 

win show one hundred and ten varieties of Darwins and May flower- 
ing. The following are a few of the popular tulips: Early singles. 
Pink Beauty, President Lincoln, Flamingo, Albut Cuyp, Wouwer- 
man. Van der Neer, Proserpine, Joost Von Vondel, (white) Calypso, 
May flowering, tulips Macs, Elegans Alba, Mrs. Moon, Moonlight, 
Ellen Willmott, Yellow Perfection, Inglescombe pink, Turenne, 
Louis XIV., The Fawn, John Ruskin. 

The May flowering are particularly beautiful, and for size com- 
pare with the Darwins. Darwin tulips are all beautiful, a few of 
the new varieties being Sir Trevers Lawrence, King George V., 
Isis, Whistler, La Tulipe Noir, Frau Angelica, Prince of the Nether- 
lands, and the well-known varieties: Europe, Psyche, Rev. Ewe- 
bank, Clara Butt, White Queen and Farncombe Sander. The 
height of these Darwin tulips varies from twenty inches to about three 
feet. Remembrants, Parrots, Double, Botanical and Bybloom tulip 
are to be seen in some gardens, but as a rule are not as popular as 
the other varieties. In the double, William III., Murillo, Courenne 
D'Or, Muriage de Ma Fille and Blue Flag are excellent varieties. 
Hyacinths are very inexpensive, and every one should plant a bed or 
force some in water or in pots for the house or office. 

The St. Thomas "Festival of Tulips," held in May, was the first 
of its kind to be held in Canada and was a grand success. Visitors 
attended from points as far east as Ottawa and from Detroit on the 
west. It is planned to make this "Festival" an annual event. Plans 
for 1917 are already being made, and it is hoped readers of Oral 
Health, who are lovers of tulips, will visit the "Flower City" next 
May. The presence of a number of dentists from different points in 
Ontario would be welcomed by Dr. Bennett and would be a most 
practical form of encouragement. 



To Polish Rubber Dentures. — After the plate is filed, scraped 
and sand-papered, instead of the felt cone use a cone made of a wine 
cork, one end of which is screwed into a chuck and the other end 
rounded with a file while the latter is revolving. On this use pumice 
in which has been incorporated some emery dust moistened. This 
cuts much faster than pumice alone, and will take out the scratches 
left by the sand-paper very rapidly. Follow this with pumice with- 
out the emery, then use whiting moistened with ammonia. If a fine 
polish is required employ prepared chalk and ammonia after the 
whiting. The commercial whiting contains considerable grit, and 
while it will polish it leaves many shallow scratches which the fine 
chalk eliminates. — F. ]. Patterson, Mendota, III (Dental Review). 



In Appreciation of the Late Major P. P. Ballachey, 
Written by W. Nelson Cuthbert, D.D.S., Brantford. 



THE late Major P. P. Ballachey was born in the County of 
Brant, and adjacent to the City of Brantford, in which place 
he received his collegiate education preparatory to his entering 
upon the study of dentistry in the Royal College of Dental Surgeons 
of Ontario, as affiliated with the University of Toronto. 

Dr. Ballachey was graduated from Toronto University and the 
R.C.D.S. of Ontario in the spring of 1899, and immediately entered 
upon the practice of his chosen profession in the City of Brantford, 
where he enjoyed a successful and prosperous practice for over fifteen 
years. 

Belonging, as Major Ballachey did, to the Dufferin Rifles, Brant- 
ford, he felt it his duty to join in the present great conflict of right and 
justice against wrong and tyranny, which had suddenly forced itself 
upon the world, and when the call came to him to leave all and go 
to the front he complied, gave up his dental practice, his wife and 
family of three little children, to join the 58th Battalion for overseas 
service. 

His home, where he conducted a residential dental practice, was 
made the headquarters for the 84th Battalion's officers while resident 
in Brantford, Mrs. Ballachey with the children having, in the mean- 
time, gone to Long Beach, California, to be near her parents in order 
to mitigate, in some small measure, for the anxiety they all felt on the 
doctor's entry into active military service. 

Major Ballachey had belonged to the military organization of the 
city for some years — the Dufferin Rifles of Canada and at the 
time of joining the 58th Battalion was junior major in the Dufferin 
Rifles, and subsequently held the office of senior major, and second 
in command of the 58th for overseas service. His battalion, the 
58th, soon reached the front, and Major Ballachey was killed in 
battle on June 14, 1916, on the very day on which Mrs. Ballachey 
had returned with her family to Brantford (their residence having 
been vacated again by the going forward of tlu^ 84th Battalion 
overseas), and their return on the day of Major Ball.ichey's death 
in battle is a very sad and strange coincidence. \\ hat makes this 
harder for Mrs. Ballachev to bear is the fact that Major Ballachey 
had been recommended for appointment as commandant of one of 
the Canadian military training camps, and had he been spared a few 
days longer would, in all human j^robability. h.we been back in 
Canada again near his family. 

Dr. Ballachey 's death came as a sudden shock to the community. 



286 ORAL HEALTH 

and particularly to the people of Brantford, where he was so well 
and favorably known. 

Major Ballachey was for ten years an active member of the Public 
School Board of Education for Brantford, during which time, chiefly 
through his influence, dental public school inspection was established 
in our city schools. The public schools of the city, as a mark of 
respect to his memory, each flew a flag at half-mast for several days, 
and at Grace Church (Anglican), where he was a devoted member 
and attendant with his family, the flag of the church hung at half- 
mast from the church tower during the Sabbath afternoon of June 
18 in sad recognition of his passing away, and fitting reference was 
made at the morning service by the Rev. Dr. Mackenzie, the rector. 
A special hymn was sung by the church choir to his memory. As 
on many past occasions he had attended his church with the Dufferin 
Rifles, when special services were held for the military, these were 
fitting tributes to his memory. 

Major Ballachey stood for everything which was for the benefit 
and advancement of Brantford, and he was known in his profes- 
sional career as a conscientious and painstaking practitioner, and 
was honored and respected alike by all. Dr. Ballachey was much 
devoted to his wife and family of little children, who will miss him 
most. But the Lord's ways are past finding out, and our friend. Dr. 
Ballachey, has fallen bravely and valiantly, doing his duty to his 
God, his King and his beloved country and the Empire of which it 
forms a part. He died leading on his troops on the battle field in 
Flanders, and we all feel that he certainly sacrificed his all to his 
country's service in time of war, and we therefore extend to his 
bereaved widow and family of little children, and also to the other 
members of his family, and particularly to his father (his mother 
having predeceased him), who feels keenly the great loss he has been 
called upon to bear, our unstinted sympathy. 

The staff of the Royal College of Dental Surgeons, and those 
members particularly of the graduating class of '99, will miss his 
kindly and genial presence when future dental meetings come to pass 
at the college. 

Major Ballachey's untimely death on the field of battle, in the 
prime and vigor of life and manhood we deplore, as the sacrifice he 
made was truly great, and greater service can no man perform than 
to lay down his life for his country. It may be truly said of Dr. 
Ballachey that "he loved Honor more than he feared Death." His 
was a death on the Field of Honor. 

"Like the memories of a sad dream come the thoughts of bygone 
friends; sad are the thoughts as dear were the friends." 



The Correct Basis for Fixing the Dental Fee. 



By a Contributor. 



THE method of computing charges for dental services has been 
adopted very largely, it is believed, by the individual upon the 
precedent established by his predecessors, or his contemporaries 
in the vicinity in which he is located. 

Whatever may be the teaching in our institutions at the present 
time, there is no doubt but that it was not many years ago that the 
college course contained nothing that might be considered a guide 
as to a fair and comprehensive means of estimating charges. 

Those who have been established for a score or more years have, 
in the majority of cases at least, continued to be wedded lo the hap- 
hazard and ill-considered arbitrary figures. Later consideration and 
teaching has abundantly proved that in arriving at the conclusion 
as to cost, very much more has to be considered than the bare 
expenditure upon the materials used or the subsidiary substances 
mvolved. 

It is not intended in this article to enter into the question of [)ro- 
portionate involvement of the expense of education, loss of produc- 
tive years, cost of furnishing and equipment, or reserve stock on hand. 
The fact that these and all overhead expense should be faithful!) 
considered has been sufficiently emphasized by others. 

Taking it for granted that it is almost entirely the practice to 
fairly consider these matters, it is in the writer's mind to deal with 
that phase of the larger subject as suggested in the title of this jniper. 

It is admitted at the outset that the writer has not adopted, as his 
basis of charges, the time involved, except in a limited degree. I hat 
the matter is prominent in his mind and that it is made subject of the 
present discussion, has been through the disagreement o\er charges 
and a consequent correspondence which, to say the least, revealed a 
peculiar attitude. The transaction and correspondence referred lo 
are considered of sufficient interest as to be given a place herewith. 
The fact that the complainant is a member of the Supreme Court 
Bench accounts for the willingness on the writer's i)art to enter into 
the discusficn so fully, and it also makes more ama/ing the charges 
and the demands made. It has been the habit of llu- writer for a 
number of years to simply present a statement of the total amount 
of the account involved, being prei)ared on demand to subm t an 
itemized bill. 1 he gentleman just referred to h.\s. Nvithin recent 
years, paid without question even larger amounts than those of the 
individuals included in this; exactly the same basis for estimate 
having been made. Having received an itemized statement of this, 
however, he presented a letter in which, among others, tho following 



288 ORAL HEALTH 

statements were made, i.e., "alleged professional services," "little 
short of polite form of robbery," being kind enough to include the 
whole of the resident dentists when he refers to the "staggering bills 
of the dentists." 

Upon the suggestion being made that the account be submitted to 
non-residents in the profession, his answer was "that would be like 
trying a goose before a jury of foxes." 

The real intent of the letter is shown in the following demand: 
"'Send an account showing number of attendances, the time spent, 
and the value of materials used, and I shall attend to the payment 
of a reasonable compensation." 

That the judiciary had conferred upon it the right to be the sole 
arbiter of professional charges outside of its own is surely surprising, 
if such a claim is made as is seemingly intended. The response to 
the above was that so far as the sender of the account was con- 
cerned, fees were not based upon the time element or upon the actual 
expense involved. The value and service rendered, the judgment and 
facility involved, and the special experience drawn upon, were all 
considered when the specific case was completed and the charge 
made. 

His request for items of cost of material and other things involved 
was dealt with rather factiously. It was stated that to arrive at 
this it would be necessary to figure the cost of actual and subsidiary 
material used, wear and tear on instruments and appliances, share 
of cost of office assistants, light, heat, power, rent, insurance, etc., 
beside the share in the interest on the cost of professional training, 
and finally there would have to be a charge made for the time 
expended in securing the above figures to make the estimate. 

The conclusion of the final letter from His Honor reads as follows: 
"I want certain information, information to which I am entitled, 
and without which in a court of law you would be disentitled to 
recover. You do not furnish it. What then?" In course of 
professional contact the writer referred to the attitude taken (without 
mentioning names) to members of five other professions. The case 
was unique in the minds of all. A physician stated that he had 
never in his experience prepared an itemized account. 

Following the last mentioned letter, the writer sent a short note to 
the effect that believing that the distrust manifested was unchange- 
able, it was an honor to enclose the account cancelled. A month 
having passed with no sequel, it would appear that the judge has 
had his desire fulfilled. 

It can readily be understood why the question as to the desira- 
bility of having a fixed stated hourly fee has been prominent in the 
mind following such a controversy. That opinions differ in this 
matter is not surprising. The desire in this paper is to seek an 
expression of opinion and secure the reasons that would account for 



ORAL HEALTH 289 

preferences. If it is the will of the editor of this magazine, the 
writer would be gratified if the advocates of the various methods of 
computing charges would present at some future time their reason: 
for believing the adoption of such as the most satisfactory. It would 
seem that it is possible to have rather diverse opinions on the one 
matter, as is manifest by two further quotations from the oft-men- 
tioned correspondence. The following are taken from the one letter: 
"Services rendered and the benefits flowing therefrom, and not the 
ability to pay, should form the true basis of payment for profes- 
sional charges. It is true that in my own profession it has the sanc- 
tion of usage that counsel fees are augmented or depreciated accord- 
ing to the magnitude or the triviality of the financial interests 
involved." 

The other statement is worthy of note, not only because it seems 
to contradict the foregoing, but also because it contains gratuitous 
information of a legal character that might be of real value in the 
contingency cf a suit being entered into in connection with any fur- 
ther case. 

"Let me point out to you one or two fundamental principles 
which, well known to the lawyer though they may be, may not, 
perhaps, be quite understood by the layman. One is that (assuming 
that there had been no scale of dentist's fees fixed by the Legislatjre, 
which I understand to be the case), in the absence of agreement as 
to prices, a dentist can recover for his services just as much as those 
services are reasonably worth and no more; worth, mmd you, not 
in the eyes of the claimant himself, but worth in the eyes cf the jury. 
Another principle, a corollary of the first, is, that in order to demon- 
strate the value of your services it would be necessary and jncu^nbent 
upon you to show the length of time that it took to pe) Form tlicni. 
You will, I think, yourself realize how utterly imj^ossible it would be 
to arrive at any just conclusion, or to ai)ply any known standard nf 
valuation with absolutely no knowledge of the essential element of 
time." 

Having exhausted the above personal matter of all (and jHissibly 
more than all) its phases of interest, it will be well to enter upon tho 
discussion of the intended topic. 

In considering the various ways in which charges have been esti- 
mated the following may be taken to cover the ground: 

One which it seems is most universally adopted is that of definite 
stated cost for definitely outlined work, with little variation, it may 
be, except for such work as gold restorations, where it i> estimated 
that the cost of the inserted article has to be definitely appreciated. 

A second method is where a minimum for every kind of work is 
agreed upon and the charge graded up contingent upon difticulties 
overcome or expense involved. 

Another that can be mentioned is a definMe consideration alto 



290 ORAL HEALTH 

gether on the skill and experience brought to play and the benefit of 
the results derived. A combination of the last two mentioned is the 
method adopted by the writer, largely, so far as the minimum fee is 
concerned, to conform to an arranged schedule of the majority of 
the local practitioners; but at the same time being a free agent to 
judge on the merits and the reward due in connection with each 
piece of operative work. In passing it may be said that the idea of 
suiting the fees to the pocket-book has not met with approval, except 
m so far as a closer adherence to the minimum standard is frequently 
adopted, in spite of the extent of the operation, in cases of those who 
are financially weak. 

The last of the methods of computing fees that is to be mentioned 
is that of estimating by time consumed. That this method is adopted 
by so many is a sufficient evidence that it has its merits, and while 
not approved by the writer, may have advantages that, when pre- 
sented, might carry unexpected weight. 

As between such a plan and that of charging by the intricacy 
involved, the skill manifested and the result secured, it seems that 
the latter is distinctly more professional. It seems almost impossible 
that such a plan could be adopted in surgery, but if it were, those 
who took advantage of such would surely not be in the same class 
for professional prominence as those whom we can call to mind who 
have achieved even international notoriety by making fees accord- 
ing to reputation and acknowledged ability. 

Those who have arrived at the stage in the practice of law where 
their advice is so highly valued, do not in the slightest estimate the 
worth of their decisions on the time consumed upon their prepara- 
tion, but upon the bringing into play the results of experience and 
knowledge. Through the effort of work of years the dentist also 
accumulates that judgment, skill and facility which render his ser- 
vice increasingly valuable, insofar as he at the same time endeavors 
to keep in the Hne of progress. Beside the increasing knowledge, the 
experienced practitioner achieves a facility at his work that permits 
him to accomplish more and more in a given period. If he is to 
derive advantage from this it must mean that the amount received 
for this period of work must be proportionately large. At the same 
lime there are times when, through personal energy, he is enabled to 
perform more or less than at others. In such a case it is only fair 
that the patient should be asked to pay for what has been accom- 
plished without entire regard to the time involved. 

It might be heresy to suggest that the sole consideration of the 
time element might tend to diminish the speed of the operator. In 
any case it can be admitted that the incentive that comes with the 
knowledge that special effort and increasing product will secure its 
due reward is by no means unworthy of consideration. 

As professional men we are probably, on the average, more Hkely 



ORAL HEALTH 291 

to live true to our obligations than are the so-called laboring classes; 
but it is a known fact that many employees would prefer to choose 
their own assistants and pay them according to their worth, than to 
be dictated to, according to union rules, as to who shall be their 
workman and the exact amount that each shall be paid, regardless 
of merit or speed. 

It would be interesting to know which of the two methods — time 
or service — would receive the more favorable consideration of a jury 
m case of a suit in connection with fees. The proper presentation 
of the case would considerably affect matters it is sure, but it 
appears to the writer that a definite statement as to exact earnings 
as per hour would to the ordinary jury seem unreasonable, as in that 
case they would be measuring by a standard with which they are 
familiar and from which the professional aspect would lose most of 
its consideration. One thing seems quite evident, and that is that 
the practitioner that has to do with that form of clientele which 
involves many calls, with examinations, relief of pain, extractions, 
anaesthesia, and attention to artificial dentures, will not be able to 
adopt a time basis without serious risk of being involved m difficul- 
ties with his patients, who will so often be on their guard so as not to 
be defrauded. Accusations have been made that the adherents to 
the time basis have "loafed on the job," but of course this is not true. 
Unfortunately, the accusation is not made to the operator at the 
time, but to his successor when the aggrieved one has changed his 
dentist. 

From the patient's point of view it has been frequently observed 
that when a specially gratifying result has been achieved in spite of 
serious obstacles, that the fee question has an unimportant part. 
comparatively, in the matter. 

Satisfied patients, both as to the quality of the work performed 
and to the ready acquiescence to charges, lends materially to tho 
comfort of practice, and whether this has been achieved by the per- 
formances of the individual dentist is a matter of whicli he is tht- 
best judge. 

The question arises as to the method of adjusting charges for 
time in connection with laboratory work, where most of this is done 
by assistants, the chair work being attended to by the practitioner. 
The results of experience in the ado|)tod method of making 
charges has, after careful computation, shown that the gross and net 
receipts are more, rather than less, than what is understood to be 
the adopted standard of those who have a fixed hour fee. so far as 
this country is concerned at least. 

Personally, there is the belief that the value of each minute's work 
is variable, and that it frequently occurs that what is accomplished 
is really worth little more than the actual cost iinolved. and some- 
times not that much. 



292 ORAL HEALTH 

In other cases the contribution of a very few minutes' actual effort 
brings about results that entitle to remuneration far in excess of the 
ordinary. 

While the writer is open to conviction as to the possibility of the 
time basis being the more satisfactory, it is improbable that even if 
such a conclusion were arrived at, that a change would be made. 
The education of a clientele along the line of a certain procedure, 
and the continuance of it over a long period, make the possibility of 
a radical change rather a formidable prospect. At the same time 
the presentation of the advantages of any favorable procedure will 
always find those who are in a position to take advantage of it. 



Prescription Writing in English/ 

Bernard Fantus, M.D., Professor of Pharmacology and 

Therapeutics, University of Illinois, College 

OF Medicine, Chicago. 



[ The folloTving article is published by courtesy of the 
*^ Journal of the American Medical Association,'' and 
discusses in a common sense way the use of Latin in 
prescription writing. The subject will, we feel sure, 
prove of great interest to the members of the dental 
profession.] 

IN the report of medical curriculum of the Council on Medical 
Education of the American Medical Association, the following 

position is taken by the sub-committee on Prescription Writing 
concerning the use of Latin :t 

The committee considers Latin desirable for the names of ingredi- 
ents (inscription) ; indifferent as to the directions to the dispenser (sub- 
scription) ; and objectionable as to the directions to the patient (sig- 
nature). The student should, however, know the meaning of the 
Latin phrases which are commonly used. This amount of Latin may 
be readily taught in the course, so far as this subject is concerned. 

While this report was not acted on by the Council, it may be con- 
sidered the most recent authoritative statement in this matter. It 
commits us to the use of Latin in at least a portion of the prescription. 

The arguments advanced in favor of Latin prescription writing are 
as follows: 

1 . "The Latin names of drugs are more definite, concise and un- 
changeable." 

*From the Pharmacologic Laboratory, University of Illinois, Colleg-e of 
Medicine. 

tReipont of Sub-committee on Pharmacology, Toxicology and Theraroentics. 
Section 4 of Report of Committee on Standard Curriculum for Medical Colleiges, 
American Medical Assrriation p 7 



ORAL HEALTH 293 

2. *'A Latin prescription can be compounded all over the civilized 
w^orld.'* 

3. '*Latin prescriptions are used internationally in medical litera- 
ture." 

4. "It guards the patient against knowledge that might be preju- 
dicial: (a) as to the physician's intention; (b) as to greater ease in 
securing the prescribed drug without a prescription, with possible for- 
mation of habit or other detriment." 

5. Better form is preserved. "To encourage the use of Lnglish 
official names would easily lead to the use of unofficial English, or 
common names, which often are indefinite; less pains would be re- 
quired in mastering the art, and the results would be probably greater 
laxity in prescribing and less familiarity with the official substances." 

Let us analyze these arguments. 

1 . The first reason advanced cannot stand, as the English official 
names for drugs and preparations are just as definite and concise as 
are the Latin names; and the latter are no less changeable, as is evi- 
denced by the changes in the official names occurring at pharmacopeial 
revisions. We must not confuse, in this connection, the English official 
names, which are given in the pharmacopeia alongside of the official 
Latin names, with the common English names, or synonyms, such as: 
Paregoric, Hoffmann's anodyne, Epsom salt, golden seal, Indian 
hemp, etc., which often are given in the pharmacopeia after the official 
English name. 

2. As to the second reason, it may be considered very doubtful 
whether it is ever desirable for a patient travelling abroad to have a 
prescription refilled without medical supervision. Even when the 
patient stays at home, indiscriminate refilling of prescriptioFis is not 
desirable. When the patient travels, there is added the lack of inter- 
national uniformity of strength of preparations (excepting in the case 
of some of the poisonous medicaments) that might lead to undesirable 
results, if a prescription calling for a U. S. P. preparation were filled 
with a preparation of another pharmacopeia having the same or 
similar name, but a different strength. 

That there is a considerable disparity in the slreM<;th o{ prepara- 
tions of various pharmacopeias may be seen from the few examples 
given in Tables I and 2. That there are not only differences in 
strength, but even qualitative differences in composition, may be seen 
from the fact that the ccm|)ound infusion of senna cont.\ins mag- 
nesium sulphate in the United States and British pharmacopeias, and 
potassium and sodium tartrate in the German and various other con- 
tinental pharmacopeias. There is also a considerable difference in 
the use of correctives; but, most of all, a decided difference in strength: 
the United States preparation representing, for instance, 6 per cent, 
of senna, while the Austrian preparation represents 12 per cent 
Fancy the predicament of a traveller who buys his compound effei 



294 ORAL HEALTH 

vescing powders or compound infusion of senna in different countries; 
he is doomed to either disappointment or discomfort. With troches 
of santonin, wine of colchicum, tincture of lobeHa, or fluid-extract of 
nux vomica, the result might easily be worse. 

The one prescription in a hundred thousand or perhaps a million 
that is carried abroad and filled there should not only be translated 

TABIjE 1.— strengths of PiREPARATIONS in various . PHARMA- 
COPEIAS, GIVEN IN PERCENTAGE OF ACTIVE INGREDIENT. 

U.S. German British Others 

Diquor sodii hydroxidi 5 . 15 . 20 . 

Oleoiim i^hosphoratum 1.0 0.1* 

Syrupus ferri iodidi 5. 5. 5.0 0.5** 

Spiirituis aetheris nitrosi 4 . 1 . 52 to 2 . 66 

Fluidextractuim inuciis vomiicae: strychnin ..1.0 1.5 

Tinctura Jobeliae 10.0 20.0 

Tinctura iodi 7.0 10.0 2.5t 10. Ot 

Ung-uentum sulphuriis 15.0 33.0 10.0 

Vinuim oolchici 10 . 0§ 20 . OH 

Vinum ipecacuanhae 10.0 5.0 

*Austrian. JFortis. 

**French. §Seed. 

tMitis. IJCorm. 



TABLE 2.— STRENGTH OF PREPARATIONS EXPRESSED AS AMOUNT OF 
ACTIVE INGREDIENT PER UNIT DOSAGE FORM. 

I 0.01 French 

Trochisci santonini ■) . 0.^ U. S. 

O.Ofi British 

Pulvis effervesoenis compositus "i "^-^ German, U. S. and British 

f 10.0 Austrian 

TABLE 3.^0FFXCIAL LATIN NAMES IN UNITED STATES PHARMACO- 
PEIA AND IN FOREIGN PHARMACOPEIAS. 

Liquor calcis Aqua calcariae — German 

Kaolinum B'olius alba — 'German, Austrian, etc. 

Plumbi cartoonas Oerussa — 'German. 

Cinchona Cortex ohinae — ^German, Austrian, etc. 

Oleum morrhuae Oleum jecoris aselli — German, etc. 

Oleoresima aspidii Extnactum filicis liquidum — Britiish 

Ergota Secale cornutum — 'German 

Nux vomica Semen .sitrychni — German, etc. 

Santonica Mores cinae' — German, etc. 

Camlbogia Gutti— German, etc. 

Hexam ethyl en am ina Hexam i n a — ^Briti sh 

Hydrargyri chliorLdum mite Hydrargyrum chloratuim — ^German 

Hydirarqyrum amiminniatum Hydrarg-yrum praecipitaitum alibuim — ^German 

Aqua hydrog-enii dioxidi Hydrog-enium peroxydatum solutum — German 

Potass'ii chloras Kalium chloricuim — ^German, etc. 

Sodii chloridum Natrium chloratum — German, etc. 

Oleum tiglii Oleuim cnotoniS' — ^Geirman, etc. 

Acetpheneitidinum Phenacetinum — ^German, etc. 

Antipyrina P'h enazonum^Britlsh 

Benzosuliphlnid'um f Glusidu;m-^Briti.sh 

' Saccharinum — German, Austrian 

Potassii bitartras Tartarus deipuratus— Oerman 

Potassii et sodii tartras Tartarus natronatuiS' — ^German 

Antimonii et potassii tartras Tartarus stibiatus — German 

into the pharmacopeial language of that country, but also revised, so 
as to be correct as regards the strength of the preparations of that 
pharmacopeia. 

3. International use of Latin in medical literature would be an 
argument of some importance in favor of Latin prescription writing; 
but, as can readily be shown, the Latin names of drugs are far from 
being international. Examples are given in Table 3. 



ORAL HEALTH 295 

Any one who reads and understands English well enough to study 
English literature would surely have no difficulty in understanding a 
prescription written in English. Should other nations retaliate by 
using their language instead of Latin, that would hardly require a 
greater knowledge of the foreign tongue than would be needed for 
the use of the literature of that language. Should, however, the other 
nations persist in the use of Latin, the knowledge needed to translate 
these prescriptions into English would be much more easily acquired 
than the ability to write Latin prescriptions correctly. In point of 
fact, however, as one looks over current literature, in various lan- 
guages, one finds very few Latin prescriptions. Generally, whenever 
medicines are mentioned, in German, French or English literature, 

ILLUSTRATIVE PRESCRIPTIONS. 

Prescription in Latin. Prescription in Ens'li.-^h. 

gm. vel c.c. sm. or c.c. 

Syrupi ipecacuanhae 8| R Ammonium chloride 51 

R Amimonii chloridi 5| Syrup of ipecac R! 

Aquae q. s ad 60| Water to make 6010 

Misce et fiat .siolutio. Mix and make solution. 

Signa: Teaspoonful in water every Label: Teaspoonful in wjiter every 

two hours. two hours. 

Prescription in Latin. Prescription in Eng-li.sii. 

gm. vel c.c. ffi". or c.c. 

R Hydrargyri chloridi mitis .... |06 R Mild morcurous chloride |06 

Sacc'hari liactis 2| Sugar of milk 2| 

Misce et divide in chairtulas x. Mix and divide into ten powders. 

Signa: One every hour. Label: One every hour. 

Prescription in Latin. Prescription in Engli.^h. 

gm vel c c S711. or c c. 

R Morphinae .sulphatis | ' R ^^orphine .^ulohate . . . I 

Extracti belladonnae. ana ... 12 Ext. ot belladonna, each .12 

Olei theobroimatis 24 1 ' *'' "I tJHM>Hrom:i -•« 

Mi.sce et divide in suppositoria xii. ^}'^ '^"^ ^'^■'^^' '"^'' twelve suppos.- 

Si"n-(: One every four hours, as tones 



needed. 



Label: One t'very four hours. :ts 
ntHMk'd. 



dosage and method of administration are discussed in the language 
in which the article is written and not in Latin. 

4. Inasmuch as it is the popular opinion that doctors use Latin in 
prescription writing to keep the laity in ignorance for selfi.^ii ends, it 
seems high time that we antagonize this idea; and wo can do this 
most emphatically by using English. This we can also do with 
perfect safety, for secrecy is verj; rarely, if ever, essential in \\\c \n\\c 
tice of the up-to-date physician, who generally prefers to lake his 
patient into his confidence than to keep him in ignorance. Deception 
is not practiced by the true physician. Ihercin lies the special differ- 
ence between the quack and the honest medical man. Furlhermor?. 
Latin prescription writing does not really contribute much more to 
secrecy than the use of English, for the Latin ami I^n^lish offnial 
jerms for drugs and pref?arations are often identical, peneuilh verv 
similar to each other. So similar are they, that certain book.-^ on pre- 
scription writing advocate the use of synonyms, as pulvis Dovcri. 
liquor Fowleri, etc., when it is undesirable in the patient's own interest 
for him to become acquainted with the treatment. \\ hen it is staled 



296 ORAL HEALTH 

that self-medication might be encouraged by the use of English, I 
fail to see the force of the argument. Is the patient more likely to 
call for sodium bromid at the drug store when it is written "sod. 
brcm.," standing for sodium bromid, than when it is intended to read 
**sodii bromidi"? 

That, with few exceptions, the use of English gives the patient no 
more and no less information than the use of Latin, may be seen from 
the accompanying illustrative prescriptions. 

In respect to the fifth reason, all that seems to be necessary is to 
call attention to the fact that the time allotted to the teaching of 
pharmacology and therapeutics is extremely limited, actually insuffi- 
cient to teach the essentials. Is it not reasonable to suppose that a 
conscientious teacher, freed of the necessity of burdening his course 
with the teaching of Latin forms, would have more time for the more 
important facts in connection with prescribing? Surely, making a 
subject more complicated does not lead to a better mastery of it. 

It has been my experience that the teaching of Latin prescription 
writing makes it difficult to get into the students' minds the really 
important facts about prescribing, namely, the "art of prescribing," 
or more specifically, the "technic of medication," which has nothing 
to do with the language used. This is a matter that is not sufficiently 
studied by medical students or practitioners; and it is not improbable 
that focusing attention on the mere language of the prescription 
causes the really important question relating to the most efficient and 
most pleasant administration of the remedy frequently to be lost 
sight of. 

It is true that students now come to us with better preliminary 
training than was formerly the case; it is also true, however, that 
even a professor of classical Latin would have to learn our prescrip- 
tion "Latin" almost as if he had not studied Latin before, for the 
Latin of prescriptions consists essentially of Latinized modern terms. 
One can find but few of them in a dictionary of classical Latin. 

That the teaching of Latin prescription writing has so far con- 
tributed but little toward the preservation of good form will be ad- 
mitted by any one who has had experience behind the prescription 
counter. An investigation§ which I conducted on the quality of 
prescription writing in this country, to which 100 leading pharmacists 
in various sections of this country contributed and which represented 
an examination of 10,000 prescriptions, showed that less than one- 
half of all prescriptions are written in correct Latin form, 36 per cent, 
of all prescriptions being written in English and 18 per cent, in poor 
Latin. If there is any error in this compilation — and it must be ad- 
mitted that modern pharmacists generally have merely a knowledge of 

§Fantus, Bernard: What Instruction Ought Medical Colleg-es to Give in 
Pharmacology and Therapeutics, Part B of Symposium, The Viewpoint of the 
Pharmacist, Quart. Fed. Sta^te Med. Boards of U. S., 1914, p. 293. 



ORAL HEALTH 297 

what might be called ''prescription Latin," it is likely to be in the way 
of overlooking minor errors in Latin; so that probably much less than 
half of all prescriptions are written in correct Latin form — surely a 
poor showing for the time and energy invested in teaching Latin pre- 
scription writing. 

Even the Latin prescriptions published in current medical litera- 
ture, in periodicals as well as in text-books, including those published 
in some books on prescription writing, contain enough errors to make 
their authors blush were they pointed out to them. Would it not be 
better to have prescriptions written in correct English than to have 
them written in the slipshod and at times ridiculous way in which so 
many of them are written at present? 

While, therefore, none of the arguments in favor of Latin pre- 
scription writing can be said to be irrefutable, a number of arguments 
in favor of English prescription writing deserve consideration. 

1. The Roman numerals, especially I and L (standing for 1 and 
50) are apt to be mistaken for each other, while our common 
numerals are much more distinct from each other in appearance 
(E. G. Eberle). 

2. Few of us are sufficiently versed in Latin to be able to express 
directions to the pharmacist that are in any way unusual. Even if we 
were capable of writing such directions in Latin, not one druggist in 
a hundred would be able to understand them. Unusual directions 
to the pharmacist are, therefore, generally written m English, even 
in Latin prescriptions, which, though endorsed in the committee re- 
port quoted above, is really less correct than using either language 
throughout. 

3. New drugs are continually being introduced, the coining of the 
Latin names for which is an embarrassment to the prescriber. 

4. It is probable that the fear of making mistakes in the Latin 
form is one of the contributing causes to that therapeutic abomination, 
the prescribing of ready-made official or pro|)rietary mixtures. LatiJi 
prescription writing absolutely stifles orii^inalit]) in prcscrihiiii^. 

5. After all, the whole proposition of writing prescriptions in 
Latin is a pretense at a knowledge of Latin, of which mcst of us 
possess so little that we would be unwilling to have our ability tested 
by one who is a recognized authority in that language. I.ncouragiFig 
students to think that it is a creditable thing to shine in a Neneer of 
knowledge as superficial as that of Latin usually is cannot but have 
a detrimental effect on the inculcation of the |)rinciple of thorough- 
ness that should guide all good teaching. 

6. By far the most imncrtant reason for writing prescriptions in 
English lies in the difficultv medical students have in learning the 
Latin form. To the student, prescription writing is a bugbear. 
When one thinks of the crowded medical curriculum and the com- 
paratively small number of hours set aside for pharmacology and 



298 ORALHEALTH 

therapeutics, it seems a pity to waste any of it on the acquiring of an 
antiquated form of expression. 

It appears that the real reason for prescription writing in Latin is 
historic. It originated in the days when Latin was the chief medium 
for exchange of scientific thought. No longer, however, are scientific 
lectures delivered in the Latin tongue, no longer are medical books 
written in Latin, no longer is it considered essential for an educated 
man to speak Latin; and yet we still feel bound to write prescrip- 
tions in that dead language. Is it not time to relieve our medical stu- 
dents of this useless burden that is put on them to the detriment of 
something else that would be much more useful to them and to their 
patients? Let us at least admit that a prescription correctly rvritten 
in official English is as good as one written in Latin. Let us permit 
students and practitioners to use whatever form they prefer, and let 
us merely hold our students for a sufficient knowledge of the Latin 
form to enable them to translate and understand such prescriptions. 
A Digest of Replies to Questionnaire on Prescription 

Writing in English. 
A preliminary draft of this article was sent to leading medical 
teachers, to deans of schools of pharmacy, and to secretaries of State 
Boards of Health. For the numerous replies obtained in return, 
and most especially for a number of suggestions received from some 
of those in favor as well as some of those opposed to the proposition, 
I wish to express my sincere thanks. An analysis of the reports gives 
the following results: 

Of sixteen deans of colleges of pharmacy who responded, ten were 
in favor of the proposition, four were opposed, and two were neutral. 
Among ninety-two medical teachers, who responded, sixty-seven 
were in favor, twenty-two opposed, and three neutral. 

In two institutions, the question of prescription writing in EngHsh 
was taken up in faculty meeting. The faculty of the School of Medi- 
cine of Yale University voted, Jan. 24, 1916, that "it was the sense 
of the faculty that English be the language of choice in instruction in 
prescription writing." The faculty of the University of Michigan, on 
the other hand, passed a resolution, Jan. 25, 1916, opposing the 
writing of prescriptions in English. In its opinion, more time, instead 
of less, should be given to Latin. 

An interesting reply was received from Prof. Gabriel Casuso, 
president cf the University of Havana, Cuba, from which I quote: 
"I believe you are right in every respect — among us, the laws govern- 
ing the matter, although they do not restrain the use of Latm, allow 
the employ of the vernacular tongue, and the pharmacists are not 
obliged to dispense prescriptions unless they are written in plain 
Spanish." 

To secretaries of State Boards of Health, the question was sent, 
"Would your examining board give a candidate a low grade, should 



ORAL HEALTH 299 

he, in an examination, write a prescription in correct English instead 
of writing it in Latin"? 

In reply to this, the following State Boards expressed, through their 
secretaries, presidents or examining officers, their willingness to accept 
prescriptions written in English at the same value as those written in 
Latin: Alaska, Arkansas, California, Connecticut, Florida, Louisi- 
ana, Montana, Minnesota, Massachusetts, New Mexico, Ohio. 
Rhode Island, Virginia, Vermont, Wisconsin and West Virginia. 

The following State Boards have declared their objection to pre- 
scription writing in English: Illinois, Iowa and New Jersey. This 
makes a total of sixteen in favor, and three opposed. 

From this it will be seen that the sentiment in favor of English pre- 
scription writing is surprisingly general. 



The Preparation of Abutments and Construction of 
Pinlay and Pinledge Attachments for Bridgework.* 



Jas. Kendall Burgess, D.D.S., New York City. 



THE subject of my clinic is "The Preparation of Abutments and 
Construction of Pinlay and Pinledge Attachments for Bridge- 
work." The case before us is one in which the upper right first 
bicuspid has been lost, and we have elected to use the second bicus- 
pid and the cuspid for the abutments. Such a case enables us to 
make both posterior and anterior attachments in one mouth and so 
condense our work. My clinic is on the attachments merely, and not 
on bridgework, so I shall not deem it necessary to go into a discus- 
sion of other details, as, for instance, why we do not content our- 
selves with the use of one attachment and construct a cantilever 
bridge for so simple a case. You will observe a fairly large com- 
pound amalgam filling in the morsal and distal surfaces. 1 his gives 
me the opportunity to bring out a point which I am very glad to 
make. Dr. Hughes, who secured the case for me. discovered thr 
cavity and informed me of it, asking my desire with reference to it. 
I asked that it be filled, care being taken to see that the filling was 
well anchored. Where teeth are well filled with material of a per- 
manent nature, I handle them as nearly as possible as if they were 
normal, preparing my cavities and obtaining my anchorage into the 
filling material, where it comes into the field of operation much the 
same as if it were tooth tissue. It will be observed also that both 
teeth are vital. One very strong claim that 1 make for these attach- 
ments is that their use rarely necessitates the destruction of the pulp. 
Where that organ is found in pathological condition its removal 

*riinir jzivoii bofdi*^ (lu- .inmial <onvoii( ioii of [ho VlrKlnl:i State D«ntal 
Society, liichiuond, Va. 



300 ORALHEALTH 

is necessitated, whatever be the operation to follow, but where a 
physiological condition obtains I believe it to be decidedly bad surg- 
ery to remove it. I am perfectly familiar with the arguments in favor 
of such a procedure as a preventive measure, but I do not concede 
their correctness, and my contention is borne out by my own experience 
and that of many other operators. But I must not forget that I am 
giving a clinic and not reading a paper. If there be those who be- 
lieve in pulp extirpation as a preliminary to bridge placement, the 
pinlay and the pinledge lend themselves perfectly to that method of 
procedure. 

We begin our operation with a saucer-shaped vulcarbo, disk 
mounted, with the convex side toward the hand-piece, and kept thor- 
oughly wet by the use of a small syringe in the left hand. We slice 
away a small portion of the mesial surface of the bicuspid, including 
the mesio-morsal and the mesio-lingual angles, but holding the disk 
at such an angle as that the mesio-buccal angle is left undisturbed. 
The resulting flat surface we call the proximal plane — the cervical 
margin of which I make no attempt to carry below the gum. I can- 
not recall having seen the occurrence of decay at one of these margins. 
Veering this plane slightly toward the lingual surface serves the 
double purpose of bringing it more completely into the field of the 
soldering operation, and keeping the metal out of view on the buccal 
surface in the finished work. We now take a flat vulcarbo disk 
about the size of a dime and cut a groove in the centre of the morsal 
surface from the morso-mesial angle posteriorly about two-thirds of 
the way towards the morso-distal angle, and in depth slightly below 
the level of the enamel. We follow in the same groove with a num- 
ber 44 cavity stonef and, by pushing and drawing, widen the mouth 
of the cavity where it leads into the proximal plane sufficiently to 
give the proper strength of union between the inlay and contour parts 
of the attachment. We follow this with a number 70 cavity stone — 
an inverted cone (a worn one serving the purpose well) — and extend 
the cavity in the morsal surface toward the morso-disto-lingual and 
morso-disto-buccal corners, leaving ample thickness of wall for 
strength. Beginning now about the centre of the bucco-lingual aspect 
of the proximal plane, and from 1-16 to 3-32 of an inch below the 
floor of the cavity, we cut a vertical groove about 1-16 of an inch 
deep mesio-distally, leading into the floor of the cavity. The cavity 
is now roughly formed, and we proceed to finish it with a number 
29 or 30 cylindrical cavity stone, paralleling and smoothing the walls, 
flattening the floor of the cavity and sharpening the angles of their 
union. Also finishing the groove in the proximal plane — the proximal 
groove — and flattening its floor — the proximal shoulder — and sharp- 
enmg the angle of union of wall and floor. We come now to the 

tAll nuimfoers of cavity stones refer to the Miller stoTies--not necess^ardly by 
way ot recommendation, but as descriptive of approxiimate sizes and shapes. 



ORAL HEALTH 301 

cuspid, and with the same large vulcarbo disk we flatten somewhat 
the disto-lingual angle, taking care not to mar the labial enamel 
plate. Now with a number 43 ready mounted stone, with its base 
at right angles to the long axis of the tooth, we cut a notch, to about 
the depth of the enamel, across the lingual surface just short of the 
cervical shoulder — the cervical notch — and another half-way be- 
tween this and the incisal end — the incisal notch. Next, with a 
number 29 cavity stone held at approximately the same angle and 
placed in the centre of the cervical notch, bearing labiallv, we cut 
the cervical groove to a depth of about two-thirds of the diameter of 
the stone. We then cut two similar grooves, the mesio-incisal and 
the disto-incisal in the incisal notch-beginning near the mesio-lingual 
and disto-lingual angles respectively, and bearing labially or slightly 
toward the pulp. The floors or ledges of these grooves should be flat 
and the angles at which they join the sides very sharp. The stone 
work is now complete and we are ready for the pin openings. I 
make it an almost invariable rule not to drill any of the pin openings 
until the stone work in all abutments is complete. By this method it 
is easier to make all pin openings parallel, and it should be said here 
that the pin openings, grooves and cavity sides of all abutments 
should be as nearly as possible parallel. For these openings I prefer 
a drill to a bur, and since I have not been able to find the proper 
size I make them myself from a number Yi revelation bur. We 
shall make three openings in the bicuspid — one just inside the enamel 
wall near the disto-lingual angle of the cavity — a corresponding one 
near the disto-buccal angle, and one about the centre of the jiroximal 
shoulder. We shall also make three in the cuspid — one about the 
centre of each ledge. They should be about 1-16 to 3-32 of an inch 
in depth. If we have made our drill correctly, these openings should 
take a 24-gauge wire comfortably. If the wire binds we may ease it 
by carrying a Yi revelation bur into each of the openings. 

The preparation being complete, we proceed to the work of con- 
struction. First, we prepare as many pins as we shall need 1 hey 
are made of 24-gauge iridio-platinum wire. After filing away the 
bur edge we bend the wire at right angle and cut ofl^ just beyond the 
elbow, making a pin slightly longer than the depth of the pin open- 
ing. A little practice will enable the operator to make these pins 
with sufficient accuracy without taking measurements. Now. to the 
matrix, which is made of ordinary inlay gold. 1-1000 or 2-1000 of 
an inch in thickness. We cut a i)iece ^ i ox ' .^ of an inch square and 
place in such a posit'on as that when carried to place it will cover 
all margins. With a ball of bibulous paper in the operating plyers 
we begin pressure, not in the body of the cavity, but at the morso- 
mesial angle and in the direction of the pulp. We follow this with 
pressure in the cavity and in the {proximal groove until the matrix is 
fairly well in position and the margins well defined. \X'e remove 



302 ORAL HEALTH 

and trim away the surplus, leaving a narrow margin around the 
cavity part, but cutting fairly close to the margin of the proximal 
plane. We anneal, replace and continue pressure with roll or several 
layers of bibulous paper under fairly sharp edge burnisher or plyer 
beaks, carrying the gold well into sharp angle formed by floor and 
sides of cavity. The matrix should now He dead to position. With 
a pointed instrument we puncture into the pin openings and place the 
pins into them, handling them by the elbow with the operating plyers. 
Having prepared small pieces of adhesive wax§ and using a fine 
pointed instrument, we place a piece at the union of each pin with 
the matrix and melt around the pin with a warmed blade burnisher. 
In the same manner we flow a thin layer of adhesive wax over the 
proximal plane of the metal, being careful not to allow it to overrun 
the margin and come into contact with the tooth. We mash a small 
piece of inlay wax between the thumb and finger and press to posi- 
tion on the proximal plane to form the contour. We now flow a 
small quantity of adhesive wax in the manner previously described 
into the cavity and against this contour to secure it. Then we com- 
plete the filling in with bits of inlay wax and a hot burnisher — shape 
the contour — -finish to the margins, carve and adjust the occlusion 
and smooth the whole preparatory to removing. We now cool thor- 
oughly with plater, place a small instrument in the morsal surface 
and one in the contour, and tease the pinlay out of the cavity. It is 
now ready for casting. 

Exactly the same methods are pursued in the construction of the 
pinledge for the cuspid up to the point of securing the pins in posi- 
tion. Following this we flow sufficient adhesive wax to sti^en the 
metal and hold it in position — burnish all margins accurately to posi- 
tion — cool and remove. It is now ready to be invested and finished 
by sweating 22k. solder over its surface. 



§Reciipe for adhesive wax: Melt together SVz oz. white wax, li^ oz. gum 
dammar, and add V2 oz. resin. Allow deibris to settle and pour into shallow 
•Qoetal box. 



Calcium Lactate as a Safeguard Against Hemorrhage. — 
It is not uncommon that cases present for extractions who give a 
previous history of severe and long-continued hemorrhage. One of 
the simplest and safest drugs for controlling this idiosyncrasy is cal- 
cium lactate. A dose of 5 gr. three times a day, for several days 
before the operation, generally ensures an absence of trouble in this 
direction. The drug can be obtained in tabloid form, and can be 
continued subsequent to the operation, if any doubt still exists as to 
the possibility of secondary hemorrhage. — Australian Journal of 
Dentistry. 



ORAL HEALTH 303 

The Ontario Oral Hygiene Ccn.millee. 



THE executive of the Oral Hygiene Committee of the Ontario 
Dental Society held its 54th meeting on Thursday, June 8, at 
the Crescent Inn, 473 Spadina Ave., Toronto, at 6.15 o'clock. 

Members present were Doctors McLaughlin, Eaton, Seccombc, 
Coyne and Reade. 

The minutes of the last meeting were read and confirmed. 

The members of the executive, elected by the Ontario Dental 
Society for the year 1916-17, are: Doctors R. G. McLaughlin, 
H. E. Eaton, R. J. Reade, N. S. Coyne and A. W. Ellis, and 
ex-officio. Doctors Wallace Seccombe, J. A. Bothwell and W. 
Cecil Trotter. 

The first business of the evening was the election of officers for the 
ensuing year. Dr. R. J. Reade being elected chairman; Dr. H. t.. 
Eaton, vice-chairman; Dr. N. S. Coyne, secretary, and Dr. A. W. 
Ellis, treasurer. 

The committee thought that the main feature of the work for the 
ensuing year should be to interest the rural districts to undertake the 
work of oral hygiene. With this aim in view the secretary was re- 
quested to get the names of the various conventions held in the differ- 
ent parts of Ontario this fall with their dates. 

The committee thought it would be a great benefit to those under- 
taking the responsibility of addressing the teachers' conventions if they 
had outlines of the various methods in which the subject should be 
presented. Dr. Wallace Seccombe was requested to draw up such 
outlines with the purpose of having the same printed by the committee 
and sent to the different men undertaking this work, so that there 
might be some uniformity in the presentation of the subject. 

Dr. McLaughlin reported that Mr. Putnam would like to have 
cur paper for publication. The chairman and vice-chairman were 
appointed a committee to look after the matter. 

An account from Mr. M. S. Weir, for the printing of the annual 
reports and envelopes, amounting to $31.00, was passed and ordered 
to be paid. 

The meeting adjourned at 9.30 p.m. 

K I Readk. Secretary. 



Obituary— Mrs. J. A. Bothwell. 

THE dental profession will learn with deep regret of the death 
of the wife of Dr. J. A. Bothwell. of Toronto. Dr. Bothwell 
may feel assured of the sincere sympathy of his dental friends 
and confreres in his loss. 



ACTIVE SERVICE ROLL 

Complimentary copies of Ohal Health will be sent during the progress of 
the war to all Dental Graduates on active service whose army address is known. 





^onttt II0U 


MAJOR 


p. p. BELLACHEY, 58th Batt. 


MAJOR 


C. B. SALE, 18th Batt., 4th Brigade. 


LIEUT. 


II. J. McLAURIN, 43rd Batt. 



CANADIAN ARMY DENTAL CORPS 



Lt.-Col. J. A. Armstrong. 
Major O. K. Gibson. 
Major A. A. Smith. 
Capt. J. W. Bell. 
Capt. C. Brown. 
Capt. J. F. Blair. 
Capt. G. N. Briggs. 
Capt. W. J. Bentley. 
Capt. G. S. Cameron. 
Capt. O. A. Elliott. 
Capt. E. A. Grant. 
Capt. W. R. Greene. 
Capt. George Gow. 
Capt. O. G. Hassard. 
Capt. J. E. Holmes. 
Capt. G. G. Hume. 
Capt. F. W. B. Kelly. 
Capt. H. Lionais. 
Capt. F. R. Mallory. 
Capt. A. E. Mullin. 
Capt. B. L. Neiley. 
Capt. E. B. Sparkes. 
Capt. G. H. A. Stevenson. 
Capt. W. G. Trelford. 
Capt. Li. N. Trudeau. 
Capt. C. F. Walt. 
tMajor W. B. Clayton. 



Capt. G. C. Bonnycastle. 
Capt. F. H. Bradley. 
Capt. C. D. DesBrisay. 
Capt. D. M. Foster. 
Capt. W. T. Haokeitit. 
Capt. W. Y. Hayden. 
Capt. Jas. M. Magee. 
Capt. H. L. Mitchener. 
Capt. J. G. Roberts. 
Capt. H. A. Sample. 
Capt. S. H. Simpson. 
Lieut. J. T. Adams. 
Lieut. S. G. Alderson. 
Lieut. N. S. Bailey. 
Lieut. J. A. Beatty. 
Lieut. F. C. Briggs. 
Lieut. T. W. Caldwell. 
Lieut. C. E. Campbell. 
Lieut. E. H. Campbell. 
Lieut. A. V. Cashman. 
Lieut. E. H. Crawford. 
Lieut. Karl Damon. 



Overseas* 

Capt. A. W. Winnett. 
Capt. J. E. Wright. 
Capt. W. W. Wright. 
Lieut. H. F. Alford. 
Lieut. G. Atkinson. 
Lieut. R. H. Atkey. 
Lieut. D. J. Bagshaw. 
Lieut. W. A. Burns. 
Lieut. G. H. Bray. 
Lieut. H. Clarke. 
Lieut. A. R. Currie. 
Lieut. G. H. Fowler 
Lieut. A. A. Garfat. 
Lieut. W. H. Gilroy. 
Lieut. D. H. Hammell. 
Lieut. J. W. Hagey. 
Lieut. H. C. Hodgson. 
Lieut. E. W. Honsinger. 
Lieut. E. C. Hutchison. 
Lieut. R. Jamieson. 
Lieut. J. L. Kappele. 
Lieut. E. J. Kelly. 
Lieut. O. Leslie. 
Lieut. A. G. Lough. 
Lieut. C. A. McBride. 
Lieut. W. G. MacNevm. 
Lieut. C. E. McLaughlin. 

Concentration Camps 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieiut. 

Lieut. 

Lieut. 

Lieut 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 

Lieut. 



J. M. Deans. 
R. L. Dudley. 
J. H. Duff. 
J. N. Dunning. 
W. R. Eaman. 
R. W. Fell. 
H. B. Findley. 
R. W. Frank. 
J. P. Gallagher. 

B. R. Gardiner. 
G. E. Gilfillan. 
J. S. Girvin. 

H. J. Henderson. 

P. J. Healey. 

F. Hinds. 

H. A. Hoiskin. 

R. O. Howie. 

G.H.Hollingshead. 

H. C. Jeffrey. 

C. M. Joyce. 
Frank Knight. 
L. Lemire. 



Lieut. R. McMeekin. 

Lieut. B. P. McNally. 
Lieut. E. McNeill. 

Lieut. H. C. Macdonald. 

Lieut. J. W. Macdonald. 

Lieut. E. D. Madden. 

Lieut. V. C. W. Marshall. 

Lieut. L. L. Matchett. 

Lieut. G. V. Morton. 

Lieut. J. F. Morrison. 

Lieut. J. B. Morison. 

Lieut. C. H. Moore. 

Lieut. P. E. Picotte. 

Lieut. H. Ross. 

Lieut. J. Roy. 

Lieut. W. A. Sangster. 

Lieut. J. F. Shute. 

Lieut. D. P. Stratton. 

Lieut. R. C. H. Staples. 

Lieut. E. S. Tait. 

Lieut. L. A. Thornton. 

Lieut. H. P. Thompson. 

Lieut. H. P. Travers. 

Lieut. D. D. Wilson. 

Lieut. Karl F. Woodbury. 
Sgt. R. J. Godfrey. 
Sgt. E. F. Jamieson. 



Lieut. T. H. Levey. 
Lieut. C. C. Maclachlan. 
Lieut. H. C. Mann. 
Lieut. W. Ma .son. 
Lieut. D. W. Massey. 
Lieut. W. J. McEwen. 
Lieut. E. F. McGregor. 
Lieut. D. K. Mcintosh. 
Lieut. J. M. Mclntyre. 
Lieut. W. S. McLaren. 
Lieut. W. H. McLaren. 
Lieut. L. D. McLaurin. 
Lieut. G. A. Munroe. 
Lieut. Otto Nase. 
Lieut. J. G. O'Neil. 
Lieut. R. M. Peacock. 
Lieut. F. H. Quinn. 
Lieut. W. H. Reid. 
Lieut. J. W. Reynolds. 
Lieut. T. E. E. Robins. 
Lieut. J. A. Ross. 
Lieut. W. J. Rutherford. 



tActing Director of Dental Services, address Ottawa. *Lieutenants rank as 
Captains while overseas. C.A.D.C. overseas address — ^Care Director Dental 
Services, Canadian Contingents, 23 Earls Ave., Folkestone, England. 



of CANADIAN DENTISTS 

Okal Hkalth will appreciate receiving names and addresses or other information ihat will make these 
pages a complete Army Service Directory constantly available to every member of thi* prufeMion. 



Concentration Camps. — (Continued.) 



Lieut. H. A. Simmons. 
Lieut. H. A. Stewart. 
Lieut. J. A. Stewart. 
Lieiut. W. G. Switzer. 
Lieut. A. J. Thomas. 
Lieut. E. L. Thompson. 
Lieu't. A. E. Wark. 
Lieut. B. L. Washburn. 
Lieut. V. D. Wescott. 

Capt. T. C. Bruce. 
Capt. A. Dubord. 
Capt. H. T. Minogue. 



Lieut. G. A. Wilcox. 
Lieut. F. M. Williamson. 
Lieut. E. H. WiLson. 
Lieut. J. H. Wiltze. 
Lieut. C. E. Wright 
Ldeut. E. H. Zirnnierman. 
Lieut. J. H. Zinn. 
Sgt. E. G. Berry. 

Divisional Officers 

Capt. F. P. Shaw. 
Capt. Geo. K. Thomson. 



SKt. T. D. Campbell. 
Sgt. H. R. Conwav. 
Sfft. H. C. Goodhand. 
Sg^t. J. C. Livett. 
Sgt. (i. R. Mf.Millan. 
Sfft. J. H. Reid. 
SK^t. H. L. Smith. 
SKt. W. J. Taylor. 



Capt. W. G. Thomp.son. 
Capt. F. M. Well.s-. 
Capt. J. M. WiI.«on. 



ATTACHED TO CORPS OTHER THAN C.A.D.C. 
Overseas 



Major G. S. Cameron, 9th C.M.R. 
Major F. T. Coghlan, 25th Battery. 
Major Chas. A. Corrigan, Army Ser- 
vice Corps. 
Capt. K. C. Campbell, 43rd Batt. 
Capt. J. R. Duff, 79th Batt. 
Capt. J. Harper, Royal Navy. 



Capt. J. L. McLean, 59th Batt. 
Capt. Walter McNallv. 170th Batt. 
Capt. S. J. Redpath. 47th Batt. 
Lieut. A. R. LegpTO, 5Sth Batt. 
Staff Sst. J. G. Roberts, C.V.M.C. 
Pte. S. P. Marlatt. Princess Pats. 



B. F. 



Lieut. Col. 

Batt. 
Lieut. -Col. Neil Smith, 181st Batt. 
Major H. A. Croll, 10th C.M.R. 
Major N. Schnarr, 94th Batt. 



Concentration Camps 

Armstrong", 159th 



Capt. A. L. Johnson. 6Sth Batt. 
Lieut. A. J. Kennedy, 114th B.itt. 
Lieut. C. XichoNon. 12:Uh Rati. 
Lieut. T. U. lU'iiloii. IHlth Ratt. 



Lieut. R. M. Barbour, 

<i4th Batt. 
F. H. Barry, C.A.D.C. 
A. Chambers, C.A.D.C. 
E. R. Dixon, 71st Batt. 
J. E. Dores, C.A.D.C. 
E. Garfat, 71st Batt. 
J. E. Irwin, C.A.D.C. 



UNDERGRADUATES 
Overseas 

J. T. Irwin, 1th l'. of T. Co 
A. W. Jones, C..\.D.C. 
J. V. Lally, C.A.D.C. 
J. G. Larmour, (\F..\. 
H. B. Legate, C.V.D.C. 
W. C. Legett, C.V.n.C. 
E. S. McBride. C..\.D.C. 
C. F. McCartney. C.A.D.C. 



Concentration Camps 



R. B. .McGuire (British 

Corps). 
R. V. McLaughlin.C.A.D.C 
T. E. Walker. r.F.A. 

A. Walton. (\.\.M.C. 

B. Watson. C..\.M.C. 
R. H. WinR. C.A.D.C. 



W. G. Alsiton, 67th Battery. 

H. R. Ander.son, 67th Battery. 

H. G. Bean, 198th Batt. 

R. Bishop, C.X.D.C. 

R. T. Broadworth, 67th Ba.ttery, 

.\. G. Calbeck. 67tih Battery. 

A. E. Chogwin, 198th Batt. 

F. Cluff. 161st Batt. 

O. G. Dailirvmplo. 67tli Battery. 
E. N. Elliott. C.A.D.C. 
R. W. Freestone. 67Ui Batt(>ry. 
H. Greenwood. 76tli Batt. 

G. E. Harper. C.FAi. 

G. M. Heisz. Div. Sig. Corps. 
A. S. Holmes. Div. Sig. Corps. 
G. W. Howson. 126th Batt. 
T. H. Hutchinson. C.A.D.C. 
J. T. Irwin. 4th V. Co. 
G. G. Jewitt. Field .A tub. 
A. N. T..r\idla\v. Mach. Gun. 




r- 




■~i 


— n 


^ THE COMPES DIL M ^ 

This Department is Edited by 
THOMAS COWLING, D.D.S., Toronto 

A SYNOPSIS OF CURRENT LITERATURE RELATING 
TO THE SCIENCE AND PRACTICE OF DENTISTRY 


n— 




z=b Lb: 





Diabetes From the Standpoint of the Dentist. 

MORE is expected of dentists to-day than formerly. Dentistry 
has attained a place as a distinct profession, having its own 
departments of specialization. Some one, with a keen sense 
for the humorous, has divided dentistry into two sections, "Septic and 
Preventive." However much we may dislike the former appellation, 
we certainly must agree as to the correctness of the latter. Preven- 
tive dentistry looms large on the horizon. As a result of modern 
methods of dental treatment it is fair to assume that more time will 
be devoted to the maintenance of a healthy condition of the oral 
cavity than to operative measures having for their object the restora- 
tion of lost tissues. 

With this in view we place emphasis upon preventive dentistry in 
our curriculum of studies. Our medical confreres, whose sympathy 
and co-operation we so much appreciate, force us to go a step fur- 
ther. They ask us to co-operate with them in preventing the pro- 
gress of ailments, not particularly dental in character, which early 
become manifest in the mouth. In effect, we are not only to practise 
preventive dentistry, but also to aid in that much larger field of pre- 
ventive medicine. The claim is not made that it is the office of the 
dentist to treat these ailments, but rather that he recognize their 
£erious import and refer the patient to a physician for early treatment. 
If such a course be followed the dentist becomes an important factor 
:n that all-important sphere of preventive medicine. 

As a concrete example illustrating this view let us refer to the very 
excellent paper published by H. H. Schuhmann, M.D., D.D.S., in 
Dental Review (May), "Diabetes From the Standpoint of the Den- 
tist. ' The following statement, made by the author in the opening 
paragraph of his paper is, in effect, a recapitulation of his views re- 
gardmg the dentist and his responsibilities in preventing the spread of 
d'sease: "The dentist may or should be able to recognize incipient 
d:abetes, and by being so observant may render his patient invalu- 



ORAL HEAL I H 307 

able service at a time when the symptoms have not as yet become 
sufficiently alarming to invite the physician's attention unless he is 
informed of the patient's condition as a result of the dentist's keen 
observation." Dr. Schuhmann points out that the usual diagnostic 
sign of diabetes is found in the analysis of the urine, and is due to 
the fact that the patient has lost either in part or entirely the ability 
to utilize or to assimilate carbo-hydrates. A symptom of diagnostic 
value is the falling off in weight with the continuance of an abnor- 
mally large appetite. There is also the voiding of large quantities 
of urine. 

There are other symptoms, however, shown in the oral cavity, and 
these hold particular interest for the dentist. In the early stages of 
diabetes there is frequently found "a very marked feeling of dryness 
in the mouth, throat, and also of the tongue. A stomatitis and gen- 
eral reddening of the oral mucous membranes is a noteworthy oral 
manifestation which is looked upon with suspicion." The author 
suggests that this condition is accounted for by the great lack of 
moisture in the mouth. Where a patient has been using a denture 
for some time without suffering any discomfort and suddenly find- 
some spots occurring on the tissues under the denture which show no 
tendency to disappear after easing the offending areas, "such cases 
should at once arouse suspicion." In diabetic subjects the aj^pear- 
ance of the tongue is characteristic. It is found "to be enlarged with 
the edges indented and marked by the pressure of the teeth. At 
times the surface of the tongue is found heavily coated, accompanied 
with these indentations, and further is apt to show deep fissures and 
cracks, which are painful and very intractible to all efforts we may 
make to cause them to heal. Again, we find enlarged and inflamed 
papillae on the tongue and mildly shining, smooth blue-red colored 
blotches, such as are frequently found in Leukoplakia." 

That there may be some difficulty in diagnosis between pyorrhoea 
alveolaris and diabetes is evident when we review the symptoms of 
this latter disease about the gingivitis or in what is most commonly 
termed "gingivitis chronica diabetica." Dr. Schuhmann describes 
this condition as follows: "The gingival, and particularly the inter- 
dental gingival margins, show dark red edges, bleed easily, and are 
painful. The whole gum tissue at the same time is swollen and 
lumified. A further development of this tissue change will be notic-d 
either in the necrotic breaking down of the gum margins or their re- 
traction, laying bare large surfaces of the teeth neck and possibly the 
alveolus. Prof. Grunert also describes whitish patches on the mucous 
membrane, which if irritated by the brushing of the teeth will break 
down into small pustules that are very painful, patients complaining 
of severe burning pains." 

The author is of the opinion that whenever inis |)ockets are found 
with rows of loose, sensitive teeth, especially where the condition has 



308 ORAL HEALTH 

appeared suddenly, a urine analysis should be made with a view to 
demonstrating diabetic conditions. Baum and Gille are quoted as 
holding like opinions in this regard. If these loose teeth of diabetic 
subjects be extracted and examined, the roots will show a peculiar 
formation — "resorptions in the shape of large deep notches and, 
according to Gruenert, at times almost needlelike pointed root ends, 
which are, as a rule, of a brownish transparent color almost like 
amber." It is not claimed that these symptoms occur in all diabetic 
cases, but that they are so frequently seen as to be taken as a warning. 
Where the teeth loosen as the result of diabetic condition, they are 
found to return quickly to a healthy condition, provided the sugar 
indications temporarily disappear or are diminished. The pulps of 
these teeth remain alive, and the pain does not subside even after the 
pulps have been removed or the teeth extracted. In this particular 
diabetes differs from pyorrhoea. 

Seme of the leading investigators on this subject are quoted as 
finding a very noticeable susceptibility to dental caries in diabetic 
patients. The author describes a typical case — "A man of seventy- 
eight years of age who ultimately died of diabetes. His teeth de- 
cayed very, very rapidly, beginning with the posterior ones and 
gradually attacking others situated further forward, the crowns de- 
caying in such a manner that nothing but rugged stumps were left. 
This patient would lose almost an entire crown in a month's time 
from decay. I found the bottom of such cavities filled with a marked 
leathery yellow-brown decay, which could be lifted almost clean 
from the underlying, slightly softened denture." 

There are some points of difference in the character of the decay 
in the cases of diabetic and non-diabetic patients. In diabetic cases 
"the decay would start on the necks of the teeth by exhibiting a 
peculiar shaped brownish or yellow spot, which could be easily over- 
looked entirely by a casual observer, but which rapidly progressed to 
actual decay around the whole circumference of the neck of the 
tooth entirely devoid of pain or of any sensitiveness, so thoroughly 
different from decay of that kind when of non-diabetic nature. The 
shape of these cavities in the beginning is a cut as if produced by a 
saw. The groove rapidly spreads towards the crown and more 
slowly towards the root end. The enamel does not seem to join in 
the process so much and is many times left like a hollow shell." 

It has been suggested that gutta-percha be used as a filling mater- 
ial m the treatment of cavities of diabetic patients, many holding to 
the opinion that the mercury contents of amalgam have a disastrous 
effect upon the gingival. Any contemplated bridgework should be 
abandoned, tartar should be scrupulously kept off the teeth and the 
pockets washed out frequently with one-half per cent, solution of 
lysol and peroxide of hydrogen. "Iodine mixtures, especially if 
mixed with chloride of zinc and glycerine, are very advantageous." 



ORAL HEALTH 309 

Loose teeth should be Hgated and retained, as they may become 
useful again as soon as healthy systemic conditions are restored. 
Extraction, if at all possible, ought to be avoided. If, however, this 
must be done, extra precautions ought to be observed. ''Thorough 
asepsis is a first and last positive requirement." Considerable diffi- 
culty may be experienced in allaying pain after extraction and also 
in getting the sockets to heal. 

It w^ill be seen from the foregoing imperfect review of Dr. Schuh- 
mann's paper that it is possible for a dentist to be of real service by 
early recognizing the symptoms of diabetes as shown in the mouth. 
The sickening, sweet breath odor, the rapid advance and peculiar 
character of dental caries, the sudden loosening of the teeth, the 
change in character of the gingival, persistent irritating areas under 
dentures — all these are indications of a condition that demands 
attention. Skill in diagnosis by the dentist will not only benefit the 
patient, but will also aid the dentist in selecting the most suitable 
remedial measures in his work. 

General Anesthesia When Making Dental Restorations. 

General anesthesia in dental operations, such as cavity pre|)ara- 
tions, has not attained the degree of importance that its earliest advo- 
cates claimed for it. Undoubtedly it has its place in general prac- 
tice, yet its use is not unattended with danger. 

For instance, it is generally recognized that one of the common 
causes of pulpal hyperemia is due to shock — the result of overheating 
the tooth. The usual remedy adopted to avoid this, such as directing 
a spray of water or air upon the tooth during the operation, is diffi- 
cultly applicable when the patient has been given, say, nitrous oxide, 
because of the necessity for rapid work. Dr. Elmer S. Best, in 
Denial Review (May) speaks of this in part as follows: *T ha\c 
come rather frequently in contact with three conditions duo to the 
use of this agent. Too extensive cutting has caused an exposure of 
the pulp. Too rapid cutting also causes an overheating of the tooth. 
or sometimes several teeth, thus hyperemia is set up. Lastly, a rather 
amusing condition. Owing to the inability of the patient to feel paiFi. 
and the hurry in which the cavities were pre|)ared. I have observed 
crowns and inlays placed on non-vital teeth with large infected peri- 
apical areas, in the assumption that they were vital teeth." 

Modern dental science has done much towards lessening the many 
difficulties attendant upon dental operations, yet that time is still 
distant when great care and laborious technique will not be requisite 
for satisfactory dentistry. We would be acting wisely, therefore, in 
not attempting to make too general an application of any new dental 
method, however efficient it may prove for a restricted and particular 
purpose, until the extent of its usefulness has been fully demonstrated. 



310 ORAL HEALTH 

Radium Emanation in the Treatment of Pyorrhoea 

Alveolaris. 

Those interested in the study of radium have been, of late, sur- 
feited with Hterature dealing with this intensely interesting subject. 
Scientific and other journals have told about all that is known of this 
new wonder. Yet, for the layman, much that has been written holds 
little interest. He has been compelled to stand, as it were, a spec- 
tator hearing much, but understanding little, of the controversy. 

Dr. Frank Marshall, in the CommonTvealth Dental RevieTV 
(March) deals with the question of radium emanation, and in a 
spirit of splendid generosity treats this subject in a manner so simple 
as to receive the commendation of those who wish to understand the 
fundamentals without being encumbered with elaborate scientific 
data. Dr. Marshall points out that "the germs of the whole modern 
theory of the electrical nature of matter, of the transformation of 
matter, of atomic disintegration are found in the discoveries of the 
Cathode rays, the X-Rays, and the emissions from spontaneously 
radio-active substances, such as uranium, thorium, radium, etc. 

Taking radium as an example, the author explains the terms 
Alpha, Beta and Gamma rays. **The Alpha rays are numerous 
and are positive eons — bodies charged with positive electricity; their 
velocity is about 20,000 miles a second, but they have very little 
penetrative power — a sheet of paper will stop them. The Beta rays 
are fewer than the Alpha rays, and are negative electrons — bodies 
charged with negative electricity. Their velocity is more than 1 00,000 
miles a second, approaching the velocity of light. They are consid- 
erably penetrating, passing straight through many bodies considered 
opaque "with sublime indifference to the properties of the bodies, 
excepting that of density." The Gamma rays are more mysterious 
and therefore difficult to define. There are few of them and they 
appear to be neutral electrically. Their penetrative power is enor- 
mous, being able to pass through a foot of iron and through several 
inches of lead." 

Having disposed of these terms, the author makes clear the mean- 
ing of radium emanation and shows for what useful purposes it may 
be used. It is pointed out that radium is in a continuous state of 
atomic activity, or rather atomic disintegration. "Its first transfor- 
mation product is a heavy radio-active gas called 'Radium Emana- 
tion,' the life of which is about 5^2 days, during which period the 
emanation in its turn is continuously transformed into other radio- 
active products, termed the 'Radio-active deposits of rapid change,' 
viz.: in succession radium A, life about four minutes; radium B, life 
about thirty-eight minutes; and radium C, life about twenty-eight 
minutes." Radium emanation is a gas and may be collected and 
held in solution in water, alcohol, petroleum, or may be absorbed by 
some solid substances, such as charcoal, meerschaum, etc. 



ORALHEALTxH 311 

Now come some interesting facts regarding radium emanation. 
"Being a heavy gas it diffuses very slowly from the liquid holding it 
in solution. It can be liberated from the liquid by vigorously shaking 
the latter or boiling it. The emanation of radium gives three times 
as much energy as the radium from which it is derived, although the 
actual amount of matter in the emanation is itself practically imper- 
ceptible. A third fact to be well borne in mind is the phenomenon 
called 'induced radio-activity,' which consists in all substances in 
close proximity to the emanation, becoming radio-active, this arti- 
ficially provoked activity, due to the absorption of the emanation's 
active deposits being very tenacious. If, for example, a rr.etallic 
wire is exposed to the emanation, and then treated with sui./>huric 
acid, and the residuum then evaporated and collected, this latter 
will be found to be still radio-active. It is with this 'induced-:=idio- 
activity' as a fundamental fact that explanations have recently been 
made of the physiological effects of internal administrations of racio- 
cmanation." 

Reverting to the problem of pyorrhoea. The author finds that the 
prevailing methods of treatment are as follows: (a) Remove ^^ 
irritants, both local and constitutional, (b) place the eliminating 
organs in a healthy condition, (c) stimulate the tissues to healthy 
action. This method of treatment involves, primarily, the restoration 
of a healthy body condition, in addition to local treatment. **I am 
of the opinion," says Dr. Marshall, "that a great many cases of pyor- 
rhoea recur for other reasons than those caused by local irritation. 
A great many of these cases are due to faulty metabolism. Irritation 
and inflammation in many cases are the characteristics of oral lesions, 
and are, in the main, reflexes and local manifestations of general 
systemic disturbances." 

New to establish the relation between radium emanation and its 
possible use in curing pyorrhea. Recognizing that faulty metabolism 
is, in a measure at least, a causative factor in the condition of 
pyorrhoea, and knowing the efficacy of radium emanation in correct- 
ing such conditions, there is reason to hope that by means of this 
agency we may be able to effect an improvement in the condition or 
perchance establish a positive cure. 

There is some clinical evidence to encourage this belief. Professor 
Traurer, director of the Dental Institute of the University of C^^ras. 
reports the results of his efforts with radium onianation water, admin- 
istered both locally and internally. "By this simple treatment I have 
got surprisingly good results. 1 he j)yorrhoea and subjective troubles 
either disappear altogether or linger with diminished seventy, only 
in the parts where there is accumulation of tartar. After the careful 
removal of the tartar, the certain disappearance of the pyorrhoea is 
secured. The pockets close, and the gums adhere again to the 
teeth. All the loose teeth become fixed. " 



312 ORAL HEALTH 

The local treatment of pyorrhoea by radium emanation consists 
in the removal of tartar, syringing out the pockets with radio-active 
water, applying cotton-wool soaked with the water to the areas of 
the inflammation about the teeth, and using the radio-active water 
as a mouth wash. When using this water as a mouth wash it is to 
be forced vigorously about the teeth for at least twenty minutes. 
This agitation has the effect of liberating the active properties of 
the water. 

Internal administration of radium emanation water is said to have 
a beneficial effect. Such treatment consists in drinking from ten to 
thirty ounces of the water daily, according to the radio-active 
strength of the water. 

The Status of the Dentist. 

Dr. J. L. Helmer, in Dental Review (June) analyzes the status 
of the dentist and finds that all is not satisfactory. Among other 
things brought to light by this investigator is the fact that "the vision 
in the eyes of the public is dim when looking at the profession of 
dentistry. They see but faintly the outline of a scientist, for to them 
dentistry is restricted to the teeth alone." The author views with 
regret the fact that although we are termed "doctors of dental surg- 
ery," yet the public demands the services of a medical doctor in 
cases of fractured jaw or similar operations. He reasons that it is 
en account of our "lack of proper education" that "dentistry is not 
honored to a higher level." The following pertinent questions are 
asked: "Are dentists proficiently prepared? Do they know the 
human organism sufficiently or the possibility of certain drugs used in 
general medicine? Are they prepared to recognize symptemic dis- 
ease as readily as they should?" 

The public, the author finds, does not give consent to the claim 
that dentistry is a branch of medical science, but considers us, "as do 
many others of our medical brothers, nothing ether than mere 
mechanicians." In order to improve this unfavorable position in the 
public esteem. Dr. Helmer would have all dentists qualify as medical 
doctors in addition to obtaining a training as dental surgeons. He 
hopes by this means to gain for dentistry due recognition. Such a 
measure would entail a prolonged course of study and might not be 
attractive to a sufficiently large number of students. The author 
recognizes this, and suggests that in order to overcome any possible 
shortage, that dental nurses be trained to do certain of the work now- 
done by dentists. 

All are agreed, no doubt, that the status of the dentist must be 
improved, yet it is doubtful if there is unanimity of opinion regarding 
the methods to be adopted for doing this. A multiplication of sub- 
jects for study will not make better students or more efficient gradu- 
ates. More time spent in teaching the essential subjects so as to 



ORAL HEALTH 313 

insure that the student understands them thoroughly and has a prac- 
tical working knowledge of same, would seem to be the wiser course. 
The public respects and recognizes those who are "masters of the 
situation" in any sphere whatsoever. 



Conductive Anaesthesia. 



R. D. Jarvis, D.D.S., London. 



OF all the present methods at our command, which can be used 
to make the operations on the teeth and jaws painless, con- 
ductive anaesthesia appeals to me the most powerfully. The 
painless performance of all dental operations has always been a sort 
of hobby of mine, and now, after having used this method of nerve- 
blocking continuously for eighteen months, I cannot say too much in 
praise of it. It is particularly applicable to the mandible, yet the 
mandibular injection is the most difficult to make. However, when 
properly executed, the results are wonderful. 

Instrumentarium. 

The instrumentarium consists of a really good hypodermic syringe. 
such as the Fischer, with steel needles 1 ^ 8 inches in length. Lither 
Anocain or Novocain Suprarenin Tablets E can be used; two tablets 
of either, dissolved in 2 C.C. of what is known as the Ringer 
Medium, will give a 2 per cent, solution. 1 he dissolving med um is 
prepared by placing 10 of the Ringer Tablets in 100 C.C. of dis- 
tilled water contained in a special receptacle, the latter then placed 
in a suitable vessel and boiled. The two syringes which I use are 
kept in a covered sterilized jar, containing a 3 per cent. Lysol 
solution. 

Preparation For An Injection. 

As much of the Ringer solution as you expect to use is poured in 
a Novocain dissolving cup, and boiled over the flame of an alcohol 
lamp; the tablets required are dropped in, not allowing them to come 
in contact with the fingers, and again boiled; then set aside until 
your syringe is ready. Removing the latter from thi' Lysol. it is 
repeatedly washed out with boiled water and alcohol. By this lime 
your solution has cooled to about body temperature and is drawn 
into the syringe ready for use. 

Preparation of the Mouth For Injection and E.xtraction. 

Spray the mouth thoroughly with a strong cleansing solution and 

paint the gums and teeth with Tincture of Iodine, particularly the 

spot where the needle is to enter must be thoroughly sterilized. If an 



314 ORAL HEALTH 

upper molar is to be removed- we make what is termed the Zygo- 
matic injection. The needle is inserted into the mucous fold directly 
over the distal root of the second molar and advanced inw^ard, up- 
ward and slightly backward in as close a contact with the bone as 
possible until the needle is completely buried; the orifice of the latter 
always pointing towards the bone. Period of waiting before oper- 
ating, 10 minutes. Anaesthesia, 1 hour. 

Mandibular Injection. 

Tlie needle is inserted about Vi inch above the level of the mas- 
ticating surfaces of the molars, and at the inner border of the ascend- 
ing ramus, advancing the needle backward and outward. The 
syringe is gently moved back and forth while injecting. Period of 
waiting, 20 minutes. Anaesthesia, 1 to 2 hours. 

Before considering the advantages of Conductive Anaesthesia, let 
me state that this method is not one for a careless operator to adopt. 
Absolute cleanliness and sterilization is imperative, with a thorough 
knowledge of the nerve supply. The advantages claimed for Con- 
ductive Anaesthesia are (1) Its long duration, (2) The large areas 
anaesthetized, with but one or two injections, (3) Infiltration of the 
mfected areas can be avoided, (4) The bloodless field of operation 
and co-operation of the patient, (5) It is a perfectly safe method, 
(6) It is dependable, the results certain and gratifying. 

However, the method is, as stated before, one not to be used by a 
careless or incompetent operator. Any dentist wishing to become 
proficient along this line should be personally instructed by an experi- 
enced operator. He should also get a skull and study the nerve 
supply thoroughly. 



Advantages of Bacteria. 



B.ACTERIA are so constantly associated with conditions of 
disease that we are apt to entirely overlook their benevolent 
activities. Without the aid of these much-maligned micro- 
organisms, Hfe itself would very scon become extinct. 

Nitrifying bacteria take hold of the waste products of animal and 
vegetable life and convert them into a form suitable for the life of 
plants. In working the soil, the farmer is simply assisting in the rapid 
development of germ life by allowing penetration into the ground of 
heat and moisture. The place bacteria fill in the digestive process is 
also worthy of note; also the woik accomplished in the purification 
of water, the chemical composition of harmful organic constituents 
being frequently changed by their action. 

Bacteria have even commercial value, being used to stimulate the 
production of butter and cream. 



ORAL HEALTH 



EDITOR 

WALLACE SECCOMBE, D.D.S., Toronto, Ont. 

CONTRIBUTING EDITORS 

GEORGE K. THOMSON, D.D.S., Halifax. N.S. 

F. W. BARBOUR. D.D.S., Fredericton. N.B. 

ASHLEY W. LINDSAY. D.D.S., Chengtu Sze Chuan 

J. WRIGHT BEACH, 

T. W. WIDDOWSON, 

J. E. BLACK, D.D.S., 

MANLY BOWLES, D. 

J. A. C. HOGGAN. D. 

EDGAR D. COOLIDGE, D.D.S., Chicago, III. 

RICHARD G. Mclaughlin, D.D.S., Toronto. 



D.D.S., Buffalo, N.Y. 

L.D.S., London, England. 

Vancouver. B.C. 
D.S., Winnipeg, Man. 
D.S., Richmond, Va. 



Entered as Second-class iMatter at the Post Office, Toronto. Sub- 
scription Price: Canada, $1.00; Other Countries, $1.25; Single Copies, 25c. 

Original Communications, Book Reviews, Exchanges, Society Reports. 
Personal Items and other Correspondence should be addresse-d to the 
Editor, Oral Health, 269 College St., Toronto, Canada. 

Subscriptions and all business communications should be addressed 
to The Publishers, Oral Health, ^9 College St., Toronto, Canada. 



Vol. VI. 



TORONTO. .JULY. 1<)U) 



\n. 



H 



E r> I T O I^I AL 



H 



A Plea for More Uniform Legislation. 



RECENTLY a writer in one of cur dental journals made a 
statement to the effect that the definition of dentustry, as given 
in the new Dental Act of the State of New ^'ork, was unsur- 
passed by that of any State of the Union. 

We have no criticism to make of that opinion, as the definition in 
question is most complete and ccncise, and one of which the profes- 
sion in that progressive state might well be proud. ^ et why should 
it be found necessary for New York to have a different dehmlion of 
dentistry from that of any other state? The practice of dentistry in 
one state of the Union cr one province of the Dominion is surely the 
?ame as any other state or province, and if so. why a different 
definition? 

On matters of dental education there has been constant endeavor 
to have every state and {province measure up to a uniform standard. 
This effort has been fraught with much good for the dental profes- 
sion of the United States and Canada. 

Why not pursue a similar policy in regard to legislation. Certainly 
there are matters of minor importance which are peculiar to tf » 



316 ORAL HEALTH 

individual province or state, and which can only be dealt with 
locally; but aside from these there are foundation principles common 
to all that might well be made the basis for all dental legislation. 
Such, for example, as definitions — Ethical Standards, the Field of 
Dentistry and Professional Discipline. 

In Canada, matters in this respect might easily be improved. Each 
province has gone its own way seeking legislation, and as a conse- 
quence we have, in the Dominion, nine different Dentistry Acts, each 
fashioned according to the professional mind of the particular pro- 
vince. 

In this young nation of ours this is a matter that might well be taken 
hold of by the Canadian Dental Association or the Dominion Dental 
Council. If in such a way the essential features of dental legislation 
were made Dominion-wide it would surely put the profession upon a 
stronger and more intelligent basis, and consequently strengthen the 
hands of the profession in the eyes of local Legislatures. 



Do You Love Flowers ? Have You a Garden ? 



NO more joy-giving or health-producing pastime exists than that 
of gardening. As a hobby for the busy dental practitioner it is 
par excellence. We want to encourage gardening among den- 
tists and appeal to the flower-lovers of the profession to send us photo- 
graphs of their garden for publication along with an account of their 
successes and failures as horticulturists. In the next issue of Oral 
Health Dr. Fred Brethour, of Toronto, will discuss and will illus- 
trate the subject by showing a corner or two of his own garden. We 
will greatly appreciate receiving snap-shots and information concern- 
ing ])our garden or photograph of any plant or flowers of which you 
are particularly proud. 



Tvv^o Names Added to Honor Roll. 



SINCE the last issue of Oral Health two more Canadian den- 
tists, serving with the Canadian Forces overseas, have paid the 
supreme sacrifice, having given their lives for the cause of 
democracy and world freedom. These are Major P. P. Ballachey, 
of Brantford, Ontario, and Lieut. H. J. McLaurin, of Winnipeg, 
Manitoba. 

Oral Health will publish elsewhere more detailed information 
concerning these two war heroes. 



l mmJUMAMiVM-MMMMM iu-.if/u/u/iJ^ninr!ii 



I 



Dental Salvation 

««« 

'T^HE secret of dental salva- 
-*- tion may be summed up 
in three lines : 

Give the teeth plenty to do ; 
Keep them clean; and 
Protect them from infection. 





Ross Thomas, D. D. S., London, Ontario 
President-elect Ontario Dental S o ci etv 



m 



m° 



m 



OPAL HEALTA 

A JOURNAL THAT STANDS FOR THE '* OUNCE OF 
PREVENTION," AS WELL AS THE ^ POUND OF CURE" 



D 



VOL. 6 



TORONTO, AUGUST, 1916 



\ 



O. (> 



The Value of Oral Hygiene Lectures to the Public 

and the Responsibihty of the Dental Profession 

in Relation to This Work. 



Thaddeus p. Hyatt, D.D.S., New York Cit^' 



BEFORE dental colleges were established it was the custom 
among dentists to keep what knowledge they had acquired to 
themselves, or to impart it to their pupils only. With the estab- 
lishment of dental colleges and dental societies, a broader view and a 
more liberal feeling came into play. Men became willing to share 
with other members of their profession the discoveries they had made, 
and as respect and honor were given to them, others strived to obtain 
honors by study and research work. The gaining of a deeper insight 
into the anatomy, histology, and physiology of the teeth gave us a 
realization of the intimate relation existing between the teeth and the 
body. The advancement made in pathology led us to believe that it 
might be possible, and even probable, that dental lesions had certain 
harmful effects upon the constitution, besides those that would come 
from poorly masticated food. The study of bacteriology, which is 
still in its infancy, is now adding evidence to prove tiuit diseased 
mouth conditions bring about systemic disorders. 

This increase of knowledge has been, and necessarily must be. 
slow, while mechanical inventions and operative skill have been 
extremely rapid, particularly in our own country. 1 he ability of 
American dentists in saving and keeping the teetii in the mouth is 
known throughout the world. In spite of the wonderful ability in 
repairing and saving the teeth, we are confronted by the fact that it 
is impossible for the dentists of the United States to repair and save 

*Read boftoro tho Virj;!ini.i Stato n»Mit,il S<u-it«ty. Kirhmon.1. V:> . Ith. .".ih. fith 
November, IDlf). 



320 ORALHEALTH 

the decayed teeth of all the people. What is to be done? The only 
answer that can be given is: we must study and teach preventive 
measures. We all know that if the teeth and the mouth are kept 
clean, the teeth are less likely to decay. We do not know as yet 
what factors there are that will produce decay in teeth that are 
clean; some claim that a clean tooth cannot, and does not, decay; 
some claim that teeth may decay in the cleanest mouth. Be that as 
it may, none deny that cleanliness is net only desirable, but it is one 
of the greatest factors in the prevention of dental lesion. None will 
deny that the presence of decaying bone tissue in the mouth, being 
mixed and swallowed with the food, is a detriment to sound and 
healthy bodies. We also know that reflect nerve irritation can arise, 
and often does arise, in a decayed tooth affecting nerves and nerve 
centres, and bring about serious results. The far-reaching influence 
of reflex nerve action we are only commencing to understand. 

For the dental profession to be of the greatest value to the com- 
munity at large, it is important and absolutely necessary to gain the 
active co-operation of the people to bring about conditions that will 
aid in the prevention of dental lesions. 

This can be done in three ways: 

1. Through the press, magazine articles, and books written in 
simple and popular style. 

2. Through the co-operation of Municipal, State, and Govern- 
ment officials. 

3. Through illustrated lectures. Of these, the one having the 
greatest educational value is the lecture, particularly that which is 
illustrated. Books, magazine articles and newspapers are of great 
value, but they have not the personal quahty which counts for so 
much in all educational work. 

The speaker is able to pause a moment and explain more in detail 
here and there just as he receives the "feel" from his audience. He 
soon learns to be able to tell at once when his audience is not quite 
certain about some point, and he quickly responds and explains more 
fully. He can change readily from the argumentative form to the 
questioning form, to which the answers are perfectly obvious. In 
this way, and with the aid of clear and simple illustrations, strong 
and lasting impressions will be made upon the minds of all. 

I have written to some of my friends asking their opinion on the 
value of oral hygiene lectures to the public, and will now read some 
of the answers: 

The responsibilities of the dental profession rest upon the knowl- 
edge of the following facts: 

1 . That reparative work alone cannot cope with the situation. 

2. That much of the reparative work is destroyed and rendered 
ureless by the same conditions which brought about the need of 

reparative work in the first place. 

3 That dental lesions net only impair the proper preparation of 



ORAL HEALTH 321 

food for digestion, but they bring about systemic disturbances which, 
in many cases, lead to serious illness or even death. 

4. That people in general are ignorant of these truths. 

5. That people in general do not realize it is within their power 
to prevent, in large measure, the establishment of these conditions in 
their own mouths. 

6. That dental lesions can be greatly lessened, and in some cases 
entirely eliminated, by proper care and attention. 

7. That preventive measures can be used by all, and that none 
are too young to learn how to practise them and understand the 
reasons why they should practise them. 

8. That none are better qualified to teach how to do these things, 
and why to do them, than the members of the dental profession. 

In an examination of over 1 ,000 cases, an average of five cavities 
to each patient was found. Following along this line of argument, 
there should be five hundred million cavities in the mouths of the one 
hundred million population in the United States. 

Allowing one-half hour as being the time necessary to prepare and 
fill one cavity, this would mean it would take two hundred and fifty 
million hours to attend to this work. If we take out holidays and 
Sundays, allowing thirty days for vacation and illness, and counting 
eight hours a day's work, we will find it will take one hundred and 
twenty-five thousand dentists one year to do this work. There are 
only forty thousand dentists in the United States. 

If one per cent, of this work needed to be done over again, owing 
to the neglect of the mouth or to other causes, we would be con- 
fronted by five hundred thousand cavities, and if any of these in- 
volved pulp removal and root filling, the allotment of one-half hour 
for each cavity would be far too small. 

But even if all this tremendous amount of work were done, we 
still would find that the cause which brought into existence the need 
of this work had not been removed. 

It is practically impossible for every dentist to give to his patients 
a talk upon the value of mouth hygiene and how to j^ractise it. It 
requires at least one hour to be able to give, with the aid of illustra- 
tions, a comprehensive talk upon this subject so that a person may 
understand in a logical and intelligent manner the importance of 
sound teeth and clean mouths, and the systemic changes which are 
brought about through ignorance or neglect. Merely to toll a i^alicnt 
how to brush his teeth does not answer the need of the present time. 
People should know, and they have a moral right to know, that many 
systemic disturbances are brought about by mouth conditions. 1 hoy 
should know, and be made to understand, that our profession can do 
but little without their co-operation and intellis^ent uFiderstanding of 
the importance of the subject. They should know that the physical 
growth and the intellectual growth of the child are jeopardized 
through neglect of mouth conditions. 



322 ORAL HEALTH 

These are some of the answers I received in reply to my request: 
"What is the responsibihty of the dental profession in relation to the 
oral hygiene campaign?'* 

I believe it can be justly claimed by those who started and have 
worked for the oral hygiene campaign that certain results have 
already been attained such as the following: 

The establishing of Dental Clinics in many of the Public Schools 
in Europe and in our country. 

The recognition by the International School Hygiene Association 
of the importance of dental attention for school children. 

The establishment of an infirmary entirely devoted to the dental 
welfare of children. I refer, of course, to the Forsyth Institute of 
Boston. 

That one of the largest life insurance companies in America, the 
Metropolitan Life Insurance Company, have established a dental 
division for their employees. Here only prophylactic work and exam- 
ination is being done. The teeth needing reparative work of any 
kind are marked on a slip and the patient told to go to his dentist to 
have the work done. You may be interested in hearing the report 
for the first three months: 

We have recently learned that Rochester is to have an infirmary 
devoted exclusively to the dental welfare of the children. 

Realize, as we must, the importance of dental hygiene and what 
may be done in the way of public education through the press and 
public lectures, the responsibility of the dental profession is very great. 
All State and local societies should use every effort to encourage their 
members to give such talks. As officers of the societies have greater 
influence than individual members, they should be the ones to visit 
the State and city officials, particularly those of the Educational 
Department, and gain their co-operation in carrying on this work. 

The New York Department of Education, through its lecture 
bureau, has for many years given lectures on oral hygiene, and last 
spring Dr. C. Ward Crampton, the director of physical training of 
the board, inaugurated a dental hygiene week. I have great pleasure 
in reading some of the notices sent out by Dr. Crampton to presi- 
dents of mothers' clubs, district superintendents, and principals of 
schools. 

The first and second district dental societies of New York State 
presented banners to the school whose children gave the best tooth- 
brush drill. These drills were held in Central Park and in Prospect 
Park. 

At Bridgeport, Connecticut, Dr. A. C. Pones and his co-workers 
have started prophylactic work in the Public Schools, and their first 
report is of great interest. Six thousand seven hundred and sixty- 
eight children received prophylactic treatment; some received one 
treatment, some two, and some three. The total number of prophy- 
lactic treatments given was fourteen thousand three hundred and 



ORAL HEALTH 323 

forty. The supervisors gave tooth-brush drills to twelve thousand 
five hundred and forty-six children. Dr. Fones and Dr. Strang gave 
stereoptican lectures to seven thousand four hundred and forty-seven 
children. 

This can be done, and should be done, in every city in the country, 
and it will be done when the members of our dental societies realize 
the importance of the work and the responsibilities resting upon them. 



Preventive Dentistry 



By Russell W. Bunting, D.D. Sc, Ann Arbor, Michigan, 



PREVENTIVE dentistry and preventive medicine are very 
closely allied. The progress of preventive medicine in the past 
few years has been rapid. Discoveries have come in quick 
succession whereby radical changes have been made in our knowl- 
edge of the subject and iron-clad ideas have given place to newer 
ccncepticns. One of the chief results of these mvestigations has been 
the accentuation of the importance of infection. Many general 
diseases, which were formerly thought to be due to a variety of 
causes, have been traced back to infection as a primal causative 
factor. The recent work of Billings, Rosenow, Hartzell and many 
others has proven without doubt that there is a direct relation between 
certain localized infections and lesions of the heart, articulatory 
joints, gall-bladder, appendix, etc. Indeed there seem to be but few 
diseased conditions which cannot be traced either directly or indi- 
lectly to infection. 

Preventive medicine of to-day is seeking to determine the ways 
and means by which the bacteria or their products gain entrance to 
the body to produce their untoward effects, and to devise methods 
by which such invasion may be prevented. The present view of the 
situation is that the great majority of these infections are localized 
about the mouth, and either they or their j^oisons find access to the 
human economy very largely by three definite avenues. 

One, by way of the tonsilar crypts. 

Second, by way of abscesses which exist in the alveolar process at 
the apex of the root of a tooth. 

Third, by way of spaces and pockets about the teeth produced by 
peridental inflammation. 

Among these important portals of entry by which infection may 
reach the circulation, two are to be found in the mouth. Because, 
then, of the proven significance of such mouth conditions and their 

♦Read before the Chicago Dental Soeiety. February 1«. 1916. 



324 ORAL HEALTH 

sinister effect upon the whole economy, preventive medicine, which 
is to be effective, must include preventive dentistry. In the practise 
then of preventive medicine and dentistry, we must seek to close 
these two avenues of infection which lie within the mouth and to 
devise methods by which these locations shall be made permanently 
impervious to the invasion of organisms. 

In the first of these two mouth conditions, we find that dental 
abscesses are very largely the result of infection introduced into the 
tissues through the death of pulps of teeth, or by filling procedures 
which are intended to replace that organ. To prevent such occur- 
rences we have sought in every way to perfect our technic of root- 
canal filling to the end that root canal infection of apical tissue cannot 
occur. But, at its best, the filling of root-canals has proven to be a 
difficult and hazardous operation. There is, in fact, but one safe 
and compatible root-canal filling, and that is a live and healthy pulp. 
Could we but keep the pulps of all teeth aHve and in health, this 
avenue of infection, in most cases, would be forever sealed. 

But the maintenance of a live pulp in a tooth, necessitates that it 
be protected from the untoward influences which irritate it and induce 
its inflammation and death. Of the sources of these harmful irrita- 
tions, by far the largest is caries of the teeth. Could we but prevent 
dental caries, the great majority of tooth pulps would remain in 
health and vital activity throughout the life of the individual. In 
the prevention of entrance of infection to the body through the avenue 
of periapical abscess, we should seek by all means to prevent the 
primal cause of these conditions, the greatest of which is dental caries. 
In the second avenue of infection we find bacteria and their toxins 
gaining entrance to the blood stream through the diseased tissues 
about the necks of the teeth. Normally, and in health, the mucous 
membrane of the mouth is resistant to infection and bacteria do not 
find an easy entrance to the deeper tissues beneath. The most vul- 
nerable area of this membrane is to be found in those portions which 
exist as holes through which the teeth have protruded. Normally, 
these tissues have a firm attachment to the peridental membrane and 
hug tightly about the teeth, but in disease this attachment and 
adaptation is destroyed, disease producing bacteria grow freely and 
find a ready access to the peridental lymph and blood spaces, 
whereby they may become a menace to the whole body. In the 
prevention of entrance of infection to the body through these tissues 
we should seek by all means to keep the mucous membrane at the 
gingiva of the teeth in good health and normal protective power. 
Thus we see that could we but thoroughly and effectively pre- 
vent these two dental diseases we would render a valuable assist- 
ance to the practice of preventive medicine in that we would thereby 
close two important avenues by which localized bacteria may pro- 
duce serious harm to the bodily economy. It is, then, the purpose of 



ORAL HEALTH 325 

this paper to review, with you, our present knowledge of the pre- 
vention of these two dental diseases. We shall attempt in such a 
presentation to classify the various causes of these two conditions 
according to the classification of causes of general disease. In all 
of which we are fully aware of the multiplicity of factors which may 
enter into the problem in each case, but we shall endeavor to state 
only those which are most prominent, which occur most frequently 
and about which we have the most definite information. 

In his classification of general diseases, Adami distinguishes two 
general groups of causes, namely, exciting and predisposing. Of 
these, the exciting causes are the proximate or active agents which 
actually produce the change in normality which result in a specific 
pathological condition. An example of this class of causes may be 
found in the infectious diseases in which the exciting cause is the 
specific bacteria which produce their characteristic disease. But 
such bacteria are not always able to produce disease. 1 hey are 
everywhere in nature and the human body is constantly brought in 
contact with them. Certain infections have a high degree of viru- 
lence which enables them to gain entrance to the tissues and produce 
disease whenever they come in contact with them. But the great 
majority of infections have not that power unless they are p:)receded 
or assisted by that other class of conditions which prepare the tissues 
of the body for the entrance of the bacteria and permit their charac- 
teristic action within the economy. The predisposing causes, there- 
fore, are in many cases, the determining factors which inaugurate 
the various disease processes. Pneumococcus is the frequent inhabi- 
tant of the mouth and throat, but in health the body is not affected 
by it. Cold, fatigue, or an attack of influenza may lower the resist- 
ance of the body and create conditions favorable for the onset of 
pneumonia. So also pneumonia in turn may become the [predispos- 
ing cause of tuberculosis of which the acid fast bacillus is the exciting 
organism. 

In applying this method of analysis to dental caries, we find that 
there is no one specific bacteria which may be spoken of as the ex- 
citing cause, but rather it is one or more of a large class of bacteria 
which are able to form acid when acting upon carl)ohydrates. Such 
organisms, when localized, produce organic acids capable of decal- 
cifying tooth structure, which process is characteristic of dental caries. 
But by virtue of the fact that caries-producing bacteria are present 
in all mouths, and that in many the disease does not occur, it may 
be seen that the action of the exciting causes is dependent upon cer- 
tain other predisposing factors which are necessary to caries produc- 
tion. This being true, the variable factors which determine the 
occurrence of caries is not to be found in the exciting causes, alone, 
but rather in those factors which are predisposing to their action. 

We, then, are confronted with a long list of predisposing condi- 



326 ORAL HEALTH 

tions which exist in the various cases in an almost endless number 
of combinations. Pickerill has estimated that there are 3,628,000 
such combinations, which is to say that of this number of caries, no 
two might have exactly the same group of causes. We have then 
in our study of the cause of caries, ceased to hope for the discovery 
of any one, all predominating factor, which in all cases, by its pres- 
ence or absence, will determine the inception of the caries process. 
We rather consider caries to be determined by the balance of power 
of several predisposing factors, which in their combinations in one 
case swing the tendency toward immunity, and in the other toward 
susceptibility. So that the study of that subject is directed toward 
the determination of the relative importance and modus operandi of 
some of these factors in the effort to establish methods of increasing 
those conditions which tend to swing the balance toward immunity. 
Of all the predisposing causes which may be concerned in dental 
caries, the following arbitrary grouping of the most prominent of 
these may be made: 

1 . The resistance of the tooth. 

2. The localization and protection of the exciting organisms, and 
the concentration of the acids which they produce upon the tooth. 

3. The amount of carbohydrates available for fermentation. 

4. The lack of neutralizing properties in the saliva. 

The importance of enamel surfaces as a predisposing factor is 
not determined. CHnically, many are convinced that certain enamels 
are soft and more easily broken down, and that such teeth are more 
prone to caries for that reason. But, in view of the fact that the 
hardest and most perfect enamel may quickly succumb to the action 
of the acids of caries, while many teeth, which are evidently of poor 
formation, may suffer little from caries, the resistance of the enamel, 
per se, does not appear to be of major importance. 

A more direct relation may be seen in those predisposing causes 
which enable the exciting organism of caries to act in a concerted 
manner, which confine the acids which these bacteria produce against 
the enamel surface, and which protect such acids from neutralization 
by the saliva. In this class of predisposing causes, we must include, 
the sulci of the teeth, all imperfections of tooth-form, overhanging 
fillings, crowns, etc., which mechanically may protect a growth centre 
of caries exciting organisms. Also there are all those irregularities 
of the teeth which make them difficult to cleanse, the amount of 
salivary mucus which has the tendency to stick foreign material to 
the teeth, the methods and habits of mastication, the personal care 
of the mouth by the individual, and all those conditions which are 
included under oral hygiene in its broadest sense. Any one, or a 
group of these above named conditions, may establish favorable 
places for the growth of the bacteria of caries, where they may multi- 
ply, produce their characteristic acids and decalcify the teeth, with- 



ORAL HEALTH 327 

out which predisposing factors the exciting causes of that disease 
could not be effective. 

But these bacteria which are capable of producing caries cannot 
be operative unless there be a sufficient amount of carbohydrate for 
their consumption in acid fermentation. So that an abundance of 
carbohydrates in the form of sugars is a predisposing factor to caries 
production. The amount of such carbohydrate is determined by 
the diet and all those factors named above which control the hygiene 
of the mouth, they simultaneously localize and protect the bacteria 
and offer means of lodgment for carbohydrates in their vicinity. 
These two classes of factors work hand in hand to augment caries. 

In our consideration of these factors there still remains one other 
class of influences which may have a greater importance than any 
which thus far have been mentioned. Cases frequently are seen in 
which, seemingly, all the foregoing predisposing causes are present, 
in which oral hygiene is imperfect and yet caries does not occur. In 
such cases it is possible that certain properties of the saliva may have 
the power to neutralize or render inert the acids which have been 
produced by fermentation. There is in most salivas a variable 
amount of alkaline principles, which if conditions allow, will unite 
with the acids of caries and prevent them from decalcifying the tooth. 
An absence, or small amount of these antacid principles in the saliva 
would be a factor of predisposition by which the acids of caries might 
become operative. 

In addition to the alkaline elements, many salivas possess an 
abundance of heavy mucus. Thus mucus may gather upon the leeth 
with great rapidity and form a veritable covering or coat for them. 
Certain of these mucinous deposits plainly are seen to be protective 
in that they absorb the acids and keep them from the enamel, and 
when broken down by bacterial action they form alkaline end-j^ro- 
ducts. Little is known of the nature, source, or action of these bene- 
ficial mucins, but it is very evident that in certain cases they have a 
very important part in the prevention of caries. On the other hand, 
it frequently occurs that the oral mucins have a high acid content 
and do not protect the tooth, but predisposes toward enamel de- 
struction. 

In the study of methods and means whereby dental caries might 
be prevented, an attempt has been made to remove the exciting 
causes of that disease by decreasing all mouth infection. It was soon 
found that if germicidal agents were used continuously, the tissues 
of the mouth were also injured and degenerations were produced, 
while the mouth flora quickly regenerated after such spasmodic 
attenuation. The most practical method of dtxreasing oral infec- 
tion is to be found in the use of washes and prophyhictic measures, 
which mechanically remove a large number of bacteria and decrease 
the food upon which they live. A thorough application of these 



328 ORAL HEALTH 

principles will very materially decrease the number of mouth 

organisms. 

As regards the control of the vast array of predisposing factors, 
which enter into the process of caries, less definite information is at 
hand and much still remains to be determined. A great deal of 
serious thought and endeavor is being given to the investigation of 
these factors in search of methods by which the predisposing causes 
may be decreased, and secondarily, the action of the exciting causes 
made less probable. 

Of all the research which has been reported, only one sugges- 
tion of a practical preventive importance at the present time has any 
general acceptance, namely, the use of fruits and fruit acids as de- 
scribed by Pickerill, Gies, and others. It has been asserted by these 
men that acid foods and mouth washes produce a reaction on the 
part of the salivary glands, which causes them to pour out a secre- 
tion which is thinner in consistency and more alkaline in reaction. 
This reaction is noted directly after the use of such foods and con- 
tinues for a short time after. Also that a continued use of such acid 
diet will result in a permanent thinning of the saliva and an increase 
of its alkaline constituents. Considerable attention has been given 
to this phase of treatment and some degree of corroboratory evidence 
of a clinical nature has been obtained. 

The plan, briefly stated, consists of the eating of fruits of a de- 
cidedly acid nature at the end of every meal and at night before 
retiring. Mouth washes of dilute vinegar or cream of tartar are 
used in the mouth toilet. In our hands, this treatment has resulted 
in a decided improvement of oral conditions in certain cases. The 
saliva has become thinner, the teeth more self-cleansing, and the 
alkalinity of the mouth is raised, all of which should have a direct 
effect in reducing the causes which predispose to caries. But in other 
instances, marked digestive disturbances are set up and the teeth 
take on an extreme sensitiveness. More clinical data should be 
obtained on this method in order that its real value may be deter- 
mined. 

In the work which Mr. U. G. Rickert and the writer have done 
in the University of Michigan during the past two years under the 
auspices of the Research Commission of the National Dental Asso- 
ciation, several phases of the problem of caries prevention have been 
attacked. Of these, there are two which seem to give the most 
promise of returns, namely, the condition of the enamel surfaces and 
the calcium content of the saliva. 

In the investigation of the enamel surfaces we have subjected a 
large number of teeth to silver nitrate, and after precipitation of the 
silver have sectioned them. By this method we have found that 
a large percentage of teeth are porous on their outer surfaces. This 
porosity usually consists of small tube-like openings, which enter the 



ORAL HEALTH 320 

enamel but a short distance, or in very poorly formed teeth, the 
permeability extends entirely through the enamel to the dento-enamel 
junction. Specially is this seen in the cervical portion of the teeth 
when the hygiene has been poor and microbic plaques have per- 
sisted, which frequently produce a complete permeation of the cer- 
vical enamel. It is seen that teeth of a high degree of organization, 
the strong highly glazed variety, are usually almost impervious to 
the silver salts. Also that teeth of an inferior quality, when worn 
by abrasion, present an enamel surface at the point of attrition. 
which is dense and lacking in porosity. When the surface of the 
ordinary forms of enamel is reduced by grinding or polishing until 
the porous exterior has been removed, the surface then obtained is 
usually dense and admits little penetration by liquids. Several teeth, 
which had been under prophylactic treatment for some time, were 
examined in this manner. They had highly polished and opascent 
surfaces, which were impervious to the silver nitrate. It did not 
appear that the enamel surfaces had been reduced materially, but 
the action of continued polishing seemed to be similar to that of 
abrasion, producing a solid and dense surface. 

All of this led us to enquire into the possibility of treating the 
enamel of the teeth in such a manner they would become con- 
densed and less pervious to the fluids of the mouth and the products 
of bacteria. Such dense and polished surfaces obviously would be 
more self-cleansing, and would offer less ready attachment for mi- 
crobic plaques, mucin, etc., which would be an important factor in 
the limitation of dental caries. The methods by which this con- 
densation may take place are not clear, but it is possible that under 
certain circumstances the calcium salts from the saliva may precipi- 
tate into the openings in the enamel and fill them. Pickerill says 
that the enamel of all teeth is extremely porous when they are first 
erupted, but that on contact with the saliva, their surfaces become 
more dense, which change the attributes to precipitation of salts from 
the saliva into the imperfections of the enamel surface. If this be 
true, and there seems to be evidence that it may be, the enamel of 
all teeth is condensed on its outer surface by virtue of some action 
of the saliva, and we may reason, a priori, that the variations in 
condensation of the enamels of various teeth is dependent to a largo 
extent upon the nature and chemical com{)osition of the saliva. Iliat 
is, that one saliva may produce hard and dense surfaces uj^oii the 
teeth which they bathe, while another saliva will lack the [iroperlies 
which are necessary for that action, and the enamel of the teeth will 
remain in the porous condition in which they were erupted. 

In pursuance of this problem we have looked into the amount of 
calcium which is available in the various salivas for this process of 
condensation. We find that the salivas of various individuals differ 
in the amount of calcium which they contain, and that in each case 



330 ORAL HEALTH 

the calcium content is fairly constant from day to day. It is also 
noted that a relatively high calcium finding in the saliva is usually 
associated with teeth which are hard and firm in texture and even 
in color, while in case the calcium is low the teeth are frequently 
whitish in appearance and do not possess good surfaces. The re- 
sults which have thus far been obtained in this study are not con- 
clusive enough to warrant making any definite statements, but the 
indications have led us to devote a considerable amount of time 
in the attempt to correlate the calcium content of the saliva with 
the condition of the enamel surfaces and the occurrence of caries. 
Of all the various principles of the saliva which we have thus far 
studied, none of them in our hands, have shown as marked a rela- 
tionship to caries susceptibility as does the calcium findings. If it 
be true that a high calcium content of the saliva serves to consolidate 
the enamel surfaces, and if by its alkaline properties it may neutral- 
ize the products of carious fermentation, the increase of that salt in 
the saliva should act as an efficient aid in caries prevention. In this 
connection we have attempted by various ways to increase the 
amount of calcium in the saliva by artificial means, such as feeding, 
stimulation, etc., and experiments are now under way at the present 
time which are directed toward that end. 

In all of this work but one feature has thus far been established 
as being of practical importance, and that is the beneficial change 
which is induced in enamel surfaces by mechanical rubbing or polish- 
ing. The enamel of teeth which are rubbed either by abrasion of 
one tooth upon another, or by the judicious polishing and cleansing 
which has been continued over a considerable length of time under- 
goes a surface condensation. This may be noted in the change in 
the external appearance of such enamel surfaces and in the decrease 
of permeability to silver nitrate. 

In a consideration of the practical methods of prevention of dental 
caries which are available at the present time we find that those 
measures which are employed in the production and maintenance of 
oral hygiene offer much that is of value. Stated in the broadest 
terms they may be said to be an attempt to make the mouth more 
self-cleansing and more easily cared for by the personal effort of 
the patient. The effect of such treatment would be the reduction 
of the amount of food debris retained about the teeth and a disturb- 
ance of the localized centres of fermentation, both of which are 
important predisposing factors in dental caries. So that such pro- 
phylactic measures, looking toward the highest state of oral hygiene, 
theoretically should prevent dental caries. The question arises, does 
It do so clinically? Regarding this there is a difference of opinion. 
Many claim that prophylactic treatment in any form, does not pre- 
vent caries, and they are very positive in their assertions as borne out 
by their own clinical experience. While of those who are practising 



ORAL HEALTH 331 

oral prophylaxis most intensically, and are giving a large portion of 
their time and attention to such practice, invariably they assert that, 
in their experience, although oral prophylaxis does not prevent every 
individual case of tooth-decay, it materially decreases the occurrence 
and in a large number of cases renders the mouth immune to that 
disease. 

In our study of the effectiveness of oral prophylaxis we have be- 
come convinced that the results to be obtained are dependent very 
largely upon the thoroughness with which these measures are carried 
out by the operator. The ordinary cleansing of the teeth has but 
little effect and is of doubtful value in caries prevention. When upon 
examination we find that in the great majority of teeth the enamel 
surfaces are rough, we can realize how quickly new deposits of food- 
stuffs and bacteria will reattach themselves to those surfaces, and 
what difficulty is offered to their removal by the action of brush and 
dentifrices. When, on the other hand, the teeth are polished until 
they are smooth on all of their surfaces, they mechanically retain far 
less extraneous matter and they are more readily cleansed by any 
friction which may be applied to them. In addition to this, the prac- 
tice of adapting all crowns and fillings so that they are absolutely 
flush with the tooth surfaces, and contouring them so that they are 
in close contact with their neighbors, and in normal occlusion with 
their antagonists, markedly decreases the amount of food retained 
about the teeth. But, no matter how thoroughly the work of cleans- 
ing and polishing tooth surfaces be done, the factor of supreme im- 
portance is that of the care which is subsequentlv given those teeth 
by the patient. Spasmodic cleansing has but little effect, and the 
continued maintenance of mouth hygiene can only be accomplished 
by proper instruction of and co-operation by the patient. 

In such cases, then, in which the highest state of oral hygiene is 
obtained and maintained, the exciting cause of dental caries will be 
diminished, the predisposing factors which cause the micro-organisms 
to become localized and which furnish the food material for fer- 
mentation will be greatly inhib ted, and the balance of caries pro- 
ducing forces may, by virtue of this condition, bo thrown over to the 
side of immunity. But if this process is but incoinj^letely carried out 
and retention centres are left undisturbed, or if uncontrollable factors 
are present which are of extreme virulence, the balance, in spite of 
all prophylactic measures may be swung toward susceptibility and 
dental caries ensue. In caries prevention, then, oral prophvlaxis nia\ 
be incomplete and leave much to be desired. Still, at the present 
state of our knowledge, these measures, when carried out in their 
most thorough manner, offer the greatest aid to caries prevention 
which are known. We fully believe that the developments of the 
studies of the subject which are now being made, will shed further 
light upon the problem and will suggest other and perhaps more 



332 ORAL HEALTH 

effective methods which will either enlarge or supplant those meas- 
ures which we now know and employ. 

In the consideration of that other group of diseases which affect 
the tissues about the tooth, we may distinguish three distinct phases 
of disturbances. The simplest of these is gingivitis, in which the 
gingival tissues undergo functional and circulatory changes; second, 
a more advanced stage of disturbance, known as interstitial gingi- 
vitis, in which the deeper tissues, the pericementum and bone become 
involved, and third, those conditions in which the deeper lesions be- 
come inhabited by pyogenic bacteria and pus is produced, namely, 
suppurative pericementitis of pyorrhea alveolaris. These three con- 
ditions are a chain of links in which one follows the other in the order 
named, and such is the order by which the great majority of peri- 
dental diseases run their course. It is true that a certain number of 
cases are seen in which the process of periden^ial tissue destruction 
is more nearly related to atropy and degeneration than to inflamma- 
tory conditions, but these, in our opinion, are extremely rare as com- 
pared with the other more commonly occurring forms, and which 
will not be considered at this time. 

Let us consider the typical case which is so frequently met with 
in its various stages of progress. Begin, if you will, with the normal 
conditions in which the gum festoons hug tightly up against the tooth 
on all sides. The color of the tissues is an even pink, being slightly 
lighter than the color of the blood. In such conditions the epithelium 
of the mucous membrane continues over the gingival crest down into 
the gingival space and unites with the pericementum at its attach- 
ment in the bottom of that space about the tooth. In such condi- 
tions the tissues are completely covered on all exposed surfaces with 
a healthy epithelium, which is resistant to the action of bacteria. 
As a rule, the first departure from normality is noted in the change 
in gum color and the loss of tonicity of the gingival tissues which 
results in their falling away from the tooth. The color of these 
tissues turns to a deeper red, denoting active hyperemia, later chang- 
ing to blue and purple when the gum circulation is in the state of 
passive or congestive hyperemia. If the process continues, inflamma- 
tion results and the health and attachment of the peridental tissues 
is impaired. Progressively, the inflammatory process is communi- 
cated to the deeper tissues with the destruction of a portion of the 
pericemental membrance and a wasting of the bone which forms 
the alveolus. When pus-producing bacteria are present, a liquefac- 
tion of these tissues is effected and true pyorrhea has been accom- 
plished. The course of this process as outlined will be determined 
by the nature and severity of the causative factors and by the vital 
activity and resistance of the tissues involved. 

And what are the causative factors of pyorrhea? This is a ques- 
tion which recently has excited much discussion and has been the 



ORAL HEALTH 333 

subject of volumes of literature. The opinions which have been 
given have been of such diverse nature, and many of them have been 
so w^ide of the truth, that a considerable confusion has arisen in the 
minds of many regarding the exact nature of the process under con- 
sideration. Indeed, these peridental affections are complicated in 
that they have many phases and manifestations, but the most com- 
monly occurring varieties are the result of certain definite conditions 
which may be classified after the manner of general diseases. 

The exciting cause of the first class of diseases known as gingi- 
vitis in a great majority of cases, is some form of local irritation. The 
irritation may be from mechanical source, such as tartar, impaction 
of food, overhanging fillings, etc., by chemical means, such as irri- 
tating acids, drugs or nicotine, or by the biochemical products of 
bacteria. Any one, or a group of these causes, by their irritating 
effects, may excite an abnormal circulation in the gingival tissues. 
The predisposing cause of such conditions are the untoward factors 
of faulty oral hygiene, which allow these irritative materials to remain 
in contact with the gingival tissues until they had produced their 
characteristic effects. 

In the second class of peridental diseases in which the deeper 
tissues have become involved, we can usually distinguish the chief 
exciting cause to be some form of micro-organism which has gained 
entrance to the gingival space from the mouth cavity. Among these 
are to be found the various forms of streptococcus, staphlococcus, 
pneumococcus, spirilla, fusiform bacillus, entamoeba, etc. 1 hese 
various organisms find in the damaged subgingival tissues a splendid 
field for growth and multiplication, where they may produce their 
characteristic action. The virulence of their attack is determined by 
the particular strain or strains of organisms which happen to be in 
predominance in each individual case. When they are of the pus- 
producing type they liquify the tissues and produce the third type 
of disease, suppurative pericementitis. 

The predisposing causes of the two more severe tyj^es of ciisoaso 
are to be found in the gingivitis which inaugurated the process, 
without which few of these deep-seated and advanced stages of 
peridental disease would exist. Cases frequently occur in which the 
exciting cause of the initial gingivitis is bacteria growing in transpar- 
ent plaques at the cervical portion of teeth. I hese same ii.icleria. 
by such preparation of the gingival tissues, may find entrance to the 
deeper structures and be the exciting cause of the more severe type 
of disease. In such cases tartar and other forms of local irritation 
may be entirely lacking. 

The question may be raised as to the part which is played by the 
internal exciting causes, such as insoluble products, which may float 
in the blood stream and lodge in the capillaries of the peridental 



334 ORAL HEALTH 

tissues, where by their irritation they may produce inflammatory con- 
ditions'. An example of such internal irritants may be found in the 
insoluble salts of mercury, which are the frequent cause of mercurial 
stomatitis. It has been found in many hospitals, where large amounts 
of mercury are given in the treatment of syphilis, that if the teeth are 
kept thoroughly clean and free from all deposits, that large quantities 
of mercury may be given without any gingivitis being produced. 
From which it may be deduced that local irritation produces circu- 
latory changes in the gums which predispose that tissue to the lodge- 
ment of mercuric salts, but in case the circulation is normal, those 
irritating materials in the blood pass through the capillaries unim- 
peded. It may also be reasonably inferred that the same conditions 
obtain in case of other drugs and auto-intoxications which may be 
present in the blood stream. 

Substantiation of this view may be seen in the fact that in those 
cases in which internal intoxications, such as gout, uremia, etc., are 
closely associated with the manifestations of peridental disease, that 
when these cases are put under treatment and the progress of the 
disease is arrested, they usually may be permanently controlled by 
the simple maintenance of strict oral hygiene. In which case, again, 
the removal of local irritation and the restoration of the gingival 
circulation to normal, markedly prevents the further lodgement of 
circulatory irritants. 

A very common chain of predisposing causes of peridental disease 
may be seen to consist of the accumulation of foreign materials and 
fermentative processes upon the teeth at their gingival border, in- 
ducing gingivitis. This in turn prepares the deeper tissue for inva- 
sion by pathogenic and pyogenic organisms from the oral cavity, 
which produce the destruction of those parts. So that in the so-called 
pyorrhetic conditions, as well as in dental caries, the important fac- 
tors of inception are not to be found in the exciting causes, which are 
always at hand, in health as well as disease, but the determining 
principle rather is to be found in those conditions which predispose 
the tissues to the action of the destructive and exciting agents. In 
the case of peridental disease these predisposing causes are very 
largely found to be some form of irritation. Mechanical, chemical, 
and bacterial irritations are to be found existing as primal causes in 
the great majority of cases without which the destruction of tissue 
by whatever the form of micro-organism would not have taken place. 
It is true that such peridental inflammation is also dependent upon 
and may be induced by departures from a state of health of the 
whole body, which may alter the circulation and lower the normal 
resistance of those tissues, but of all the cases which are presented 
for clinical study, those which are produced by the local irritative 
factors by far overbalance those which are of a general or system 
source. Evidence of this is seen in the marked improvement which 



ORAL HEALTH 335 

is obtained in practically all cases when the mouth is placed in the 
state of strict hygiene. 

Prevention, then, of such conditions should consist of the perfec- 
tion of methods of procedure by which these various local irritating 
materials might be continuously kept from the vicinity of the gingival 
tissues and the resistance of all mucous surfaces raised to the highest 
degree. This again involves the obtainence and maintenance of the 
highest form of oral hygiene. Polishing and shaping of the teeth, 
and artificial substitutes so that they may be self-cleansing and offer 
the least possible retention to food debris, tends to diminish the irrita- 
tion by food impaction, and enables the patient by proper training 
and co-operation to keep the teeth relatively free from all irritative 
materials. In addition to this, the patient in the personal care of his 
teeth, if a stiff brush be properly used high up on the gums, will 
stimulate the circulation to the gingiva, and will by friction excite the 
formation of a thicker and tougher epithelium, which will be more 
resistant to injuries than is the average. In this manner he simulates 
the harsh scrubbing of coarse and tough foods which the lower ani- 
mals consume, and which so largely have disappeared from our diet. 
Clinical evidence has shown that mouths so cared for seldom suffer 
from gingivitis the first stage of the process. It is also clinically 
evident that, in all those cases in which gingivitis has set in, the sur- 
gical removal of all tartar and elimination of centres of food accu- 
mulation, the polishing of the teeth and the proper care by the patient 
usually results in a return of the tissue to a permanent normality. 

It is further seen that the most successful operators upon peridental 
diseases to-day are confining their treatment to simple measures of 
absolute oral cleanliness. They do not enquire as to the exact nature 
of the specific organisms involved, but direct their energies solely to 
rendering the entire crown and diseased root surfaces as smooth and 
self-cleansing as possible. With such surgical treatment alone, they, 
in a great majority of cases, induce the peridental tissues to return to 
r. healthy state, and are able to maintain them as such as long as the 
practice of oral hygienic principles be continued. May it not there- 
fore be reasoned, that in such cases had these same oral hygienic 
principles been employed previous to the inception of jieridental dis- 
ease that it would not have occurred? 

But in order that these prophylactic measures which ha\e been 
referred to be a benefit to the dental t'ssues, all such operations nuist 
be carefully and judiciously carried out. Excessive and unwarranted 
grinding of the enamel will j^rcduce sensitiveness to the teeth and 
great discomfort to the patient. So also, extensive and vigorous in- 
strumentation of tooth surfaces beneath the normal gingiva will injure 
the attachment of the peridental tissues to the root and will destrov 
the very relations which we seek to conserve. It is to be denlored 
that many operators, with seemingly good intent'ons. are sacrificing 



336 ORAL HEALTH 

a considerable portion of enamel substance, and are destroying the 
close proximal contacts in their effort to make teeth self-cleansing. 
Such practice is wholly unwarranted, unnecessary and dangerous. 
The object to be obtained is a polished enamel surface, and this 
may be attained in most instances by the removal of but an infini- 
tesimal thickness of enamel substance. This may be compared to 
the polishing of a gold crown, in which an effort is made to obtain 
a smooth surface with a minimum loss of gold thickness, and the 
smooth surface so obtained is subsequently given a high polish. So 
also the enamel surfaces beneath the gingiva and in the interproximal 
surfaces may be smoothed and polished by careful instrumentation 
and safe and sane methods of technic, but in all cases the greatest 
care must be exercised to prevent the injury or destruction of soft 
tissues, which are in the state of normality or near normality at the 
time. Such operations must then be safely and sanely performed, 
but to be effective they must be so thoroughly carried out that all 
irritations be completely removed. Such simple, conservative and 
thorough measures, in the great majority of cases, will maintain the 
normal tissues in health and will produce a decided improvement in 
those which are suffering from peridental disease. 

In conclusion, we may say that in the practice of preventive den- 
tistry, as applied to caries and peridental disease, the most practical 
measures of procedure lie in the production and maintenance of oral 
hygiene. If we would prevent caries, we must keep the teeth free 
from the localization of bacterial growth and accumulations of food 
materials. If we would prevent peridental diseases we must prevent 
all local irritations to the gum tissues. We should make it an invari- 
able practice to examine tooth surfaces and read the gum colors in 
all cases which come under our supervision. We should consider 
the slightest change from the normal pink color of the gingiva as a 
signal of danger, and should bend every energy in the effort to re- 
move the irritation of whatever nature it may be, and continue such 
prophylactic measures until the peridental tissues have returned to 
their normal color and tone. We should endeavor to perfect our 
technic of oral prophylaxis beyond the point of simply cleaning teeth, 
but rather strive to produce tooth surfaces which are mechanically 
smooth and polished, in a condition in which they may be kept rela- 
tively clean. We then should direct the efforts of our patients by 
frequent and personal supervision and insist that each surface of 
every tooth be properly cleansed at least once daily. And in all our 
consideration of these diseases we must not overlook the intimate 
3 elation of the health of the whole body to the health of the mouth 
tissues, and by suitable corrective and prophylactic measures of a 
general nature seek to bring the health of the whole body to its high- 
est state of perfection whereby we will most effectively render it 
immune to disease — Dental Review. 



Horticulture for the City Dentist, 



Fred G. Brethour, D.D.S., Toronto. 



[Dr. Brethour has met with exceptional success this year 
Tvith some of the products of his garden. At the Jul}) 
Show of the Toronto Horticultural Society Dr. Brethour 
exhibited Peonies and Perennials (open class) and was 
awarded the gold medal in the latter class and first and 
second prizes in the former. This article will doubtless 
prove both a help and inspiration to the city dentist who 
taf^es health and pleasure out of his flower garden. — 
Editor. ] 

IT is said that the average professional Hfe of a city dentist is but 
twenty years. Why should this be so? A dentist is not [)rac- 
tising very long before he realizes that he has chosen an exacting 
profession. The nervous strain and close confinement, the intense 
application of the mental faculties, along with more or less worry, 
soon begins to tell. The wise dentist regulates his hours and takes 
some form of relaxation to restore lost energy, while the foolish one 
works along in the same old rut untn he peters out, and we read in 
the mornmg papers of some one of our most promising practitioner > 
being cut off in the prime of life. 

It is necessary that some form of recreation should be adopted. 
Some try one thing, some another. I have had a number of fads, 
and the latest and most lasting of these is horticulture, and I want 
to advance a few reasons why I think this is ideal. Right here I 
would like to give a few words of advice to the young dentist, and 
that is to buy a house, even if he can only make a small payment. 
Buy a good one, too; you can pay for it all right. I here is not the 
least bit of doubt of that if you are any good. And see that there 
is a decent sized lot with it, and while you are about it try to get as 
good soil as possible — that will helj) you out later. 

It is maintained that every third generation iiuist get back to the 
land for the good of the race, and what would be belter still for you 
and yours would be for you to be in close touch with mother nature 
all the time. This is possible with even a small piece of ground, such 
as is found in an ordinary city lot. What I am going to say applies 
solely to the growing of flowers, but it can also apply to any other 



338 ORAL HEALTH 




Peonies 

form of horticulture with equal benefit. Now, what are the benefits? 
In the first place, it is essentially an outdoor recreation for at least 
nine months of the year, and yet it is not merely an occupation for 
the bright days of spring and summer. When you begin to study 
the nature and requirements of what you are growing, and all other 
subjects parallel with that, a task awaits you for each and every day 
of the whole year. Who can name another form of recreation that 
is good for the whole three hundred and sixty-five days? 

The love of flowers is instinct in mankind. The youngest child 
loves them, and in later years, to grow and perfect them is one of 
the purest, most interesting and most delightful of all human pleas- 
ures. Gardening establishes in one's character the virtues of patience, 
will power, diligence and application. It develops the faculties of 
observation, ingenuity, foresight and alertness. Its moral effect, per- 
haps, is the greatest of all. The colors, the perfumes, the birds and 
the butterflies, the bees and the insects, some good and some bad — 
the metamorphosis from the tiniest seed, to a tall plant with a beauti- 
ful color and delicious fragrance, cannot help but have a refining 
and a softening tendency. 

A garden makes a family fond of their home. The children love 
it. All through the days of childhood it is their fairyland of sweet 
enchantment and innocent wonder. Then, again, if we consider the 
physical aspects of gardening, it has no equal. As I said before, it 
takes you outdoors. It brings into play nearly every muscle (I have 
no use for one who gets a man to do the hard work). It thus invig- 
orates and makes your nerves steadier. It creates a healthy appetite, 
and as an antidote for worry and insomnia it cannot be excelled. 
You sleep like a hired man on Sunday morning. 

Now, you say this sounds fine. Tell us how to do it. That is a 
long story, too long for such an article as this. I might say that five 



ORAL HEALTH 339 

years ago I knew very little of the fine points of the game. I joined 
the Toronto Horticultural Society, where they have scientific papers 
in the winter months and flower shows in the summer months. I 
bought books. I wrote to the Agricultural College at Oitawa for 
everything they had of any value. I also wrote to Washington, and 
sent enough money to pay for numerous pamphlets. I hen I got all 
the catalogues I could hear tell of, and now I can tell a Scotch 
thistle from a peony all right. We will say you have a piece of 
ground 30, 40 or 50 by 125 or 150 feet. Now if you want an 
artistic garden aim at simplicity. You cannot make an Italian 
garden or a Japanese garden with that space. The setting for your 
garden must be your lawn. Flowers are an adjunct. Learn some- 
thing about lawns, how they should be made, and then fertilize and 
keep up. Don't make the mistake of having flower beds scattered 
here and there; confine them to the borders. As for borders, make 
them at least five feet wide, from that to twelve feet, and make your 
outline in nice, graceful curves. Straight lines are very inartistic, but 
often have to be used in some places, however. You thus make a 
plan for your border. Now comes the real work. Your ground 
must be well cultivated and fertilized. The fall is the time to do 
that, and don't undertake too much at once, for it must be done well 
if you are going to grow perennials. I grow nothing else and culti- 
vate the ground in this way. Mark off about 30 or 40 feet in 3 or 
4-foot spaces. You will find ordinarily that the top six or eight 
inches is fairly rich. That's the top soil, of course. From your first 
3 or 4-foot space remove this top soil and convey it to the end of 
your 30 or 40-foot space. Now you have your sub-soil. We will 
say it is pretty heavy clay. This has to be dug down two feet and 
thrown up on the sides. You will have a hole now almost three feel 
deep. Throw in your well-rotted manure, a good layer, and dig 
this in thoroughly before putting in any of the earth, then add a i>or- 






Delphinium 



340 ORAL HEALTH 

tion of your soil and throw in more manure, and dig this in thor- 
oughly. Keep doing this until you have the earth all back. This is 
called trenching. Start on your next space, and the top soil of it is 
spread over the space you have just been w^orking on, and so on, 
until you have finished. For fertilizer you can use well-rotted horse 
or cow manure, supplemented if you wish with sheep manure, bone- 
meal, woodashes, etc. Do a little of this digging every night and 
morning and you won't need anybody to rock you to sleep. Now, 
what have you got? You have a soil that is not going to peter out 
the first year. I haven't said anything about drainage. Most To- 
ronto land is naturally well drained. Supposing this is all you are 
going to cultivate the first year, get busy on your catalogues. Decide 
what will give you continuation of bloom, what color combination 
will harmonize, and figure out the tall growing stuff from the low 
growing. Don't see how many different things you can plant in that 
space. The best effect is in grouping a number of the same things 
together, never less than three of a kind. Plant only the good things. 
If you cannot get the best varieties here, import them from England, 
or France, or the United States. It is just as easy growing good 
varieties as ordinary ones and much more satisfactory. For con- 
tinuation of bloom, for April and early May you must depend on 
bulbs. I prefer Darwin and Cottage tulips and daffodils. These 
must be planted in the fall. For later, May, there are aquilegia, 
trollius, pyrethrums, iris, etc. For June you have poppies, peonies, 
roses, campanulas. For July roses, delphinium, early phlox, thalic- 
trum, lillies, Japanese iris, etc. For August, roses, phlox, Shasta 
daisies, etc., and for fall there are rudbekias, roses, chrysanthemums, 
Michaelmas daisies, heleniums, etc. Then you have the whole shrub 
family from which you can get bloom the whole season, and the 
climbers. Plant your stuff in the spring the first year, with exception 
of bulbs, lillies. Oriental poppies and peonies, which should be 
planted in the fall. 

This is beginning to get complicated. Don't expect you are going 
to do everything right from the start. You will learn a whole lot by 
experience — the same as in your profession. You are not going to 
learn much out of books, but it will help you a lot to get some good 
gardening magazine. 

Now, we will imagine your plants all growing nicely, where does 
the pleasure come in? You will find all this is pleasure. You have 
forgotten all about that nervous patient you were working for, or 
about that fellow who left the country owing you your fee. You get 
up early in the morning, about five o'clock we will say, you will hear 
the singing of birds you never heard before, you will get whiffs of 
perfume that are the strongest at that hour, you will nose around to 
see what new flower the fairy fingers have opened up during the night, 
and with your sharp knife you will just snip off a nice bunch of roses. 



ORAL HEALTH 341 

or two or three nice peonies, or whatever you fancy, and put them 
in water to be taken to the office. Is it worth while having a bunch 
of real fiowers in the office, or is it just as well to have an old fern 
with rusty leaves, or nothing at all? I think a nicely arranged 
bouquet of fresh flowers in the office is a tonic to a nervous patient, 
and besides it lends a tone of refinement, and it shows that the den- 
tist is making an effort to subdue the cold and forbidding look of the 
ordinary office. You put a few choice flowers in the office, and nine 
patients out of ten will speak about them. All women are lovers of 
flowers; there is a sympathetic bond between you, and I believe you 
can get along better with them. At any rate, you will have to tell 
all about those flowers, how you grow them, where to get them, and 
you are spreading knowledge, which possibly will make the world a 
little bit brighter. That's doing your "bit" to beautify the city. By 
giving this one a few seeds, and that one a plant or two, you perhaps 
are starting some one on your hobby, which cannot help but have a 
beneficial effect on the individual and on the community as a whole. 
Why not help to make your city a city of beautiful gardens? 



Technique of Root Canal Filling. 



Department of Operative Dentistry, Royal College of 

Dental Surgeons. 



Preparation of Operator and Assistant. 

THE operator and assistant should be dressed for aseptic oper- 
ating. Hands should be scrubbed and dipped in alcohol. It 
is not necessary for the hands to touch any of the materials or 
instruments which enter the canals, rubber gloves may be worn. 
Preparation of Field of Operation. 
The patient's mouth should be sprayed and rinsed with flavored 
water (wintergreen or peppermint). 
Rubber dam put in position. 

Teeth exposed through rubber dam wiped off with alcohol or 
phenol. 

Sealing removed. 

Cavity wiped with alcohol and dried with warm air. 
Dressing removed from canal and tested for odor and moisture. 
If the dressing is dipped into H.. O., effervescence will indicate pres- 
ence of organic matter. 

Preparation For Operation. 
Bracket Table. 

All instruments used in any former operations should be removed 
and only those of immediate necessity kept on the table. The whole 



342 ORAL HEALTH 

root canal equipment should be brought forth to the table sterile and 
ready for use without being handled by operator or assistant. The 
instruments and materials may be taken directly from the steriHzer 
as they are needed or from towels containing them which have been 
sterilized. 

Among the equipment should be a number of smooth broaches 
already wound with absorbent cotton, cotton rolls, cotton pellets, 
rubber dam, cotton wipes, root canal cleansers, root canal reamers 
and root canal pluggers of various sizes and forms as well as dressing 
forceps and other pluggers. 

Dr\)mg of Root Canals. 

With sterile cotton on smooth broaches carry alcohol into the canal. 
Wipe out the excess alcohol with the prepared broaches and cotton 
and apply hot air. If using a chip blower draw the air through the 
flame into the rubber bulb, thus sterilizing the air and gradually blow 
into the canal. If using compressed air this is sterilized by passing 
through a vapor bath. Now pass a heated broach into the canal 
as often as necessary or until all fizzing ceases. This broach is made 
from piano wire or irrido-platinum. The canal is now dry and 
ready to receive the filling. 

Indications For Use of Chlora-Percha. 

1. In all root canals freely opened to the apex, but which have 
not large apical openings. 

2. In canals in which posts are to be cemented. 

The Technique of Insertion. 

Moisten the canal with oil of cajuput or eucalyptus. Dry out 
excess of the lubricant with cotton. Pump chlora-percha into the 
canal with a smooth broach, a little cotton on the broach may assist 
at first, then pump with a smooth broach several times. It is usually 
wise to pump until the patient gives response. If the canal is hard 
to fill use unvulcanized rubber as in pressure anaesthesia to force the 
chlora-percha home. Select a gutta-percha cone which approxi- 
mately fits the canal to the apex and pass it up the canal, perhaps 
withdrawing and re-inserting several times until it is well settled to 
place. Several cones may be required to fill the canal. If the 
patient responds to any pressure wait a few minutes and then press 
the cone farther. An easy way to handle the cone is to flatten the 
large end with a pair of pincers. When the cone is passed into 
the canal as far as it will go, pack and force it home with a root 
canal plugger, being careful not to punch holes in the cone and thus 
remove the mass. To accomplish this use a wad of cotton or paper 
over the gutta-percha to receive the thrust of the plugger. Cold air 
blown on the gutta-percha while packing facilitates the evaporation 
of the chloroform and makes a denser mass. Warm air or warm 
instruments expand the gutta-percha; cover the gutta-percha with 



ORAL HEALTH 343 

oxy-chloride of zinc or oxy-phosphate with 5 per cent, red oxide of 
mercury added to prevent infection. 

The Indications For the Use of Rosin Solution. 

1 . In fine canals which can be thoroughly dried. 

2. Canals which have been the seat of septic infection. 
The Technique of Insertion. 

Flood the dry canal with a thin rosin solution pumping it in with 
a wisp of cotton on a small smooth broach. When the canal is full 
pass a fine bristle to the apex and let out any air that may be en- 
trapped. This is of vital importance. (For X-Ray purposes dip 
the broach in oxide of bismuth and pump into the canal.) Now pass 
the gutta-percha cone up the canal. Have a rigid cone and pass it 
half way up the canal and pump up and down forty or fifty times, 
as it dissolves, pass further toward the apex. The solution will enter 
the tubuli. When the canal is full, pack down with a cold plugger 
and wipe away any excess rosin solution. Rub steel {^luggers on 
paraffin or cocoa-butter to prevent them sticking to cone. Fill pulj) 
chamber with oxy-chloride of zinc or oxy-phosphate to which has 
been added 5 per cent, red oxide of mercury. 

Indications For the Use of Paraffin Compound. 

1. Large canals freely opened. 

2. Under fillings where no force or pressure is going to drive it 
through the apex. 

3. If apical irritation is feared. 

The Technique of Insertion. 

With a wisp of cotton on a bristle moisten the canal with pure 
paraffin oil or liquid alboline. Now place a paraffin cone in the canal 
and pack it to place with a heated copper wire (about 60 C), add 
enough paraffin to completely fill the canal and have the whole in a 
liquid state so as to leave a homogenous mass when the broach is re- 
moved. Pass a gutta-percha cone, or better, a copper wire into the 
canal and leave permanently. Seal the pulp chamber with oxy- 
chloride or oxy-phosphate to which has been added 5' - rod oxide of 
mercury. 

Indications For the Use of Bismuth Paste. 

1 . Roots with large apical openings from absorption or lack of 
development. 

2. Temporary teeth. 

3. Punctured roots. 

4. Bifurcated openings. 

The Technique of Insertion. 

Place the jar of paste in a hot water bath and when the mass 
is liquified carry some to the tooth with a syringe. 1 he nozzle of the 



344 ORAL HEALTH 

syringe must be warm and large enough to take up and discharge 
the paste. It may be necessary to pack unvulcanized rubber around 
the nozzle to force the paste into the canal or use the rubber as a 
piston as in pressure anaesthesia. A gutta-percha cone may now be 
gently passed into the canal. 

Indications For the Use of Mumnifying Paste. 

1 . In fine root canals where it is impossible at the tirrie to remove 

all the pulp. 

2. A temporary expedient. 

Technique of Insertion. 

Moisten the canal with oil of cajuput or eucalyptus. Dry out 
the excess of the lubricant with cotton. Pump the mumnifying paste 
into the canal with a smooth broach, a little cotton on the broach 
may assist at first, then pump several times with a smooth broach. 
If the canal is hard to fill use unvulcanized rubber as in pressure 
anaesthesia to force the mumnifying paste home. Select a gutta- 
percha cone which approximately fits the canal, perhaps withdraw- 
ing and re-inserting several times until it is settled to place. Cover 
the mumnifying paste with oxy-chloride of zinc or oxy-phosphate to 
which has been added 5% red oxide of mercury. 

Materials For Filling Root Canals. 
Cutta-Percha and Chlora-Percha. How to Maf^e: 

T^ke a jar that will hold about two to four ounces, fill it about 
three-quarters wiih pink base-plate gutta-percha cut into squares or 
strips small enough to settle well into the bottom of the jar. Pour 
over this enough chloroform to cover the gutta-percha fully. Allow 
to stand for a few hours, closely covered. Shake well, and much 
sediment will fall to the bottom; gutta-perchas now used are loaded 
with oxide of zinc and other materials that are not suitable ingredi- 
ents of chloro-percha for filling root canals. To remove these strain 
through cheese cloth into a wide mouth bottle with an outside cover, 
which is not so likely to become smeared as a cork that fits inside. 
Finally, ground thymol crystals may be dissolved in chloroform and 
added, or may be thrown into the liquor undissolved — use about two 
or three drachms of thymol to an ounce of gutta-percha. As the 
chloroform evaporates add oil of cajuput to the solution to keep it 
liquid. After some months all the chloroform will have evaporated, 
and the gutta-percha will be held in solution by the oil of cajuput. 
This chloro-percha will be ropy and tenacious — not so short grained 
as that made from base-plate gutta-percha unstrained. 

Cutta-Percha Cones put in a wide mouth bottle and covered with 
alcohol will thus be kept sterile and ready for use^ 

Pink gutta-percha is preferable to white, because the color makes 
a sufficient contrast to the teeth tissue to be easily followed if removal 
should be necessary. 



ORAL HEALTH 345 

Rosin and Cutta-Percha Compound. 

Rosin Gr. xll 

Chloroform 3ii j 

M. Fiat Sol. 
Place the rosin in a wide mouth bottle and add the chloroform, 
let stand for a few hours when it will be ready for use. A little 
vaseline put on the glass stopper of the bottle will help to keep the 
chloroform from evaporating. 
Paraffin Compound. 

Thymol 2 parts 

Bismuth trioxide 30 parts 

Hard Paraffin (melting point) 

56-58 deg. C. (133-136 deg. F.) 68 parts 

The above formula may be put up by your druggist. 
A very convenient and aseptic method is to have the paraffin for 
the compound made into cones and placed in alcohol. Liquid Albo- 
line, Russian Oil or Petroleum is used as a lubricant for the canal. 
Bismuth Paste. 

Bismuth-Sub-nitrate 30 parts 

Yellow vaseline 60 parts 

White wax 5 parts 

Paraffin 5 parts 

Mumnifying Paste. 

Oxide of zinc. 

Creosote or Oil of Cloves. 

Hymol. — Hva Yaka. 



Our Buffalo Letter. 



By Habec. 



I WILL just dash off a few lines to let Oral HraltH kiuns that 
poor old Habec is still able to answer "pi'^^^^n^" ^o ^^^^ ^^^^ ^'^'^ ^^ 
Nearly Has-Beens. No doubt you had. mentally, placed a 
sprig of Acacia to mark the spot where hallowed memories might 
return to commune with the spirit of the departed devastator of the 
English language, but Habec hereby serves due and timely notice 
upon creditors and debtors alike that he is still on deck to give and 
receive as grudgingly as ever. Were it not that your typewriter 
(neuter gender) seems to be seriously afflicted by intermittency of 
action, and, in consequence, your reminder of Habec' s long- delayed 
^communication so infrequent, you would, doubtless, be saved the 
^9K0|t>y of such long suspense. However, we believe that you have 



346 ORALHEALTH 

a right to more fully understand our reasons for playing the clam at 
a deaf-mute party. 

It is all on account of the Preparedness League of American Den- 
tists. Several moons since we organized the above institution, and 
although the three starters have worked very hard and undergone 
much personal inconvenience thereby, yet we have fully demon- 
strated the great need of the movement, and are satisfied that many 
times the personal effort thus far expended would be worth while. 
If you will print the principal points in the enclosed circular letter it 
will save the repetition of the objects of the work. We have a mem- 
bership of over 1 ,200, representing thirty-eight states, Canada, Hono- 
lulu, Porto Rico and the Philippines. We have prepared a good 
many recruits who were rejected because of inadequate dental out- 
fits and the most of them are now at the Mexican border. Several 
un"t3 have been established at different points for the practice of war 
oral and dental surgery, and many more are in process of organiza- 
tion. 

The trustees of the National Dental Association extended us the 
privileges of the organization by giving the League a place on its 
programme at Louisville on July 25th inst., besides tendering the use 
of the Seelbach Hotel for an afternoon meeting. As at present 
arranged the speakers will be: Dr. J. D. Patterson, Kansas City; 
Dr. H. J. Burkhart, Batavia, N. Y. ; Dr. H. E. Friesell, Pittsburgh, 
Pa., and H. A. Pullen, Buffalo. Habec will wield the gavel and 
pass the ice water. 

Habec could write much on this subject, but he has ground it over 
and over so many times that it would only be a repetition, and no 
doubt many of the readers of Oral HEALTH have seen articles on 
the subject in different dental journals and know our spiel by heart. 
We would like to add, however, that it is a wonderful work, and if 
we had ten times the energy to give we would be happy to place it 
on the altar of the Preparedness League of American Dentists. 

Trusting we may be able to send you a little of the old time non- 
sense before long, we are, as always, Habec. 



Oral Health publishes herewith a resume of a circular letter 
issued by the Preparedness League of American Dentists. 

Dr. J. Wright Beach (otherwise known and most highly regarded 
as Habec) is chairman of the committee on organization, and along 
with his associates deserves great credit for the energy that has been 
shown in making the League an active force in the solution of the 
present dental problem of the United States army. 

We quote as follows: 

*'The Preparedness League of American Dentists is organized to 
aid our Army Dental Corps by the voluntary service of its members, 



ORAL HEALTH 347 

and its active usefulness will cease when the Army Dental Corps 
becomes adequate to meet the demands upon it. 

"It is primarily a registration bureau for all dentists of the United 
States, who agree to prepare the mouth of at least one applicant to 
meet the requirements for enlistment, subject to such rules as shall 
protect the dentist from imposition. 

"Registration entails no further obligation on the members than is 
herein stated. It is the desire of the organizers to be able to assure 
the Surgeon-General of the United States Army, not later than July 
1, 1916, that twenty thousand dentists have joined the League. 

"This movement is for the purpose of providing immediate aid for 
our War Department, when exigencies require, and will in no way 
conflict with present or future legislation affecting the Army Dental 
Corps. 

"Furthermore, the committee on organization has formulated a 
plan whereby those injured about the face and jaws during battle 
may receive skillful surgical and mechanical treatment by a corps of 
dentists specially trained for such purposes. 

"Sections will be formed, with units in many of our cities, where 
instructions and clinics will be given in reference to special oral surg- 
ery and pathology, reduction of fractures, construction of splints, bone 
grafting; in short, such new conditions as have developed from the 
great war now raging in Europe. Dentists who have served at the 
American and other ambulance hospitals in Europe, and others of 
international reputation in their special branches, will assist in this 
work. 

"It hardly seems necessary to add that the organizers of the 
League receive no compensation for their services, the object being 
purely humanitarian in character. Therefore, they feel justified in 
soliciting your earnest co-operation in a cause, the motives of which 
must ring true, and could be prompted only by American iiatriotism. 

"Members will be active and associate. To become an active 
member of the League, the enclosed application blank must be 
accompanied by one dollar ($1.00). An associate member may 
register with the League by forwarding the application blank with- 
out fee, full membership to be consummated upon payment of the fee 
when requested by the League. 



Cavity Toilet Preparatory to the Insertion of Synthetic 
Porcelain. — The toilet of a cavity preparatory to the insertion of a 
synthetic porcelain filling must be as thorough as if a metal filling 
were to be used. To the ordinary toilet should be added the var- 
nishing of the dentinal walls as a precaution against the material 
absorbing either acid or moisture from the walls or against the absorp- 
tion of part of the fluid from the material by excessively desiccated 
dentin. Usually the rubber dam should be applied. Western Den- 
tal Journal. 



ai l IP 

' THE COMPENDIUM 

This Department is Edited by 
THOMAS COWLING, D.D.S., Toronto 

A SYNOPSIS OF CURRENT LITERATURE RELATING 
TO THE SCIENCE AND PRACTICE OF DENTISTRY 



The Dental Nurse. 

TWO of the most disturbing problems in dentistry is that of the 
treatment of children's teeth and prophylaxis. They are dis- 
turbing because, in the first place, time and patient effort, far 
exceeding that thought necessary by the average person, are re- 
quired, and secondly, because of the frequent lack of appreciation of 
such efforts. 

No one who has had experience in dental practice will take issue 
with the statement that the care of children's teeth calls for the ex- 
penditure of more nervous energy than is the case in the treatment of 
adults. Parents do not, as a rule, take kindly to the suggestion that 
such services ought to be rewarded on the basis of the time spent. 
Hence a situation quite unsatisfactory both to operator and patient 
is presented. The dentist is required to spend time for which no 
reasonable compensation, except in rare instances, is offered, yet this 
work is important and must be attended to. 

Disease of the first teeth is capable of producing lasting injury to 
the health of the child. Irregular eruption and unsightly malocclu- 
sion are often caused by the premature loss of the temporary teeth. 
Bone deformities, which often interfere with breathing, etc., may be 
the result of the neglect of the early teeth. Quite frequently we hear 
this question discussed by dentists. All are agreed that the need of 
the little folks for efficient dental care is vastly important, yet most 
confess to a lack of desire for this class of work. "Educate the 
parents to appreciate the value of our efforts," they say, "and we 
will then gladly do our part." Holders of this view may be charged 
■- with being imbued with the spirit of commercialism, yet all dentists 
cannot be philanthropists, in the sense that they can afford to give 
ten hours of. professional service and receive therefor, the pay of a 
street-+sweeper. ^r 

n-" The difficulties attendant upon dental treatment for children has 
^ oHate been lessened a good deal, especially in the larger : centres i of 
population;' where dental clinics have been introduced-by rauriici- 



ORAL HEALTH 349 

palities and Boards of Education. In these clinics, where the ex- 
penses of operation are borne by the community, more time can be 
spent on this class of dentistry than would be possible in the case of 
one conducting a private practice. 

Then there is the question of prophylactic treatment. An hour's 
time for treatment of an adult is, in most instances, not too liberal an 
allowance. On the basis of time spent, such treatment would call 
for a fee of, say, five to eight dollars. This might not be objected 
to in some instances. It would be a case of attempting professional 
suicide, however, for many dentists to follow such a schedule. All 
patients, even though recognizing the merits of the dentist's claim for 
a suitable fee, may not be in a position to pay it. Yet these patients 
may be in urgent need of dental treatment. In brief, then, the situa- 
tion is this: There is a great and recognized need for service to be 
given children and adults of a type that involves the expenditure of 
much time as well as skill. The dentist has the skill, but cannot 
spare the time. How is the situation to be met? 

A solution, or near solution, has been found in the introduction of 
the dental nurse or dental hygienist, a person with legal standing 
just recently introduced to the public by legal enactment in the State 
of New York. These nurses are permitted to practise to a limited 
extent, oral prophylactic measures. Commenting on the introduc- 
tion of this new statute, the Dental Register says: 

"There can be little question as to the necessity for these prac- 
titioners. There is a vast need, not only in our public schools, but 
children who are still too young to be in school, children in hospitals 
and institutions, and even hospital patients of every age can be cared 
for as by no other means at present available. The field is enormous, 
and it will take a long time to educate enough hygienists to take care 
of this public service, to say nothing of the work demanded in con- 
nection with private practices." 

Aspirants for this new department must have had at least one 
year's attendance at high school, followed by one year's training in 
oral hygiene. This course of training may be taken at any dental 
dispensary or infirmary, legally incorporated and maintaining a 
proper standard and equipment. 

There never has been much difficulty in securing assistants in the 
dental office because this sort of employment seems to appeal to 
many. There has always been, however, a lack of what may be 
termed "suitable" applicants. Few men have had the temerity to 
state what they consider to be desirable qualities in a dental nurse 
or assistant; at least no publication of such views are cm file, (^f 
unusual interest, therefore, is a paper by Carrie Johnson \V ilev. pub- 
lished in the Dental Pacific Gazette (June) entitled "The !\ffici«'nt 
Dental Nurse." Herein are stated some of the views held by a 
graduate nurse regarding the requisites of the efficient dental assist- 



350 ORAL HEALTH 

ant. This is the author's initial requirement: 

"It is absolutely necessary that she try to create an attractive envir- 
onment and thus display a tendency to eliminate the fears of the 
dental office or the sick room. Very often the bearing or demeanor 
of the nurse has been severely criticized by the clients of the office, 
and such a criticism has occasionally been just. We must bear in 
mind that too much reservedness on the part of a nurse is interpreted 
as haughtiness, indifference, or perhaps cold-^bloodedness. The art 
of conversing pleasantly, gently, sympathetically, and yet in a non- 
committal tone is by no means an easy task. It is one vv^hich re- 
quires much thinking and is surely worthy of cultivation. Further- 
more, we should remember that personal cleanliness, neatness, whole- 
someness, and the capacity to meet requirements as they arise are the 
factors which engender confidence." 

The writer is addressing an association of dental nurses and does 
not fail to caution them on that all-important subject — the nurse's 
personal attitude towards her employer. This is her way of treat- 
ing this difficult topic: 

**It (the nurse's attitude) should be becomingly respectful. I re- 
member once hearing a nurse (a graduate of a recognized school) 
addressing the doctor as "Doc." I am sure that he did not know 
whether she meant a place in which to tie a boat, or whether she 
was speaking of a bob-tail horse. There is a vast difference between 
frankness and familiarity, and the nurse who has learned the differ- 
ence has laid a good foundation for promoting harmony between her 
employer and herself." 

There is such good sense in these remarks that one feels tempted to 
suggest that they receive a wide circulation among present and aspir- 
ing dental assistants. In doing this a splendid service would be 
rendered the profession, especially if the following paragraph from 
the same author's paper be included: 

"A busy man cannot afford to give his time to trivial matters, nor 
to give thought to things which are far remote from his profession. 
One's personal affairs are most interesting to oneself. They may be 
endured by others, out of politeness, but oftentimes through force of 
circumstances their narrative brings about revelations which are 
afterwards regretted. Few people are criticized for talking too little; 
some of us are bubbling over with the enthusiasm of an interesting 
life, and it seems that we simply must express ourselves, but if we 
endeavor to think more and say less I am sure that some of our 
employers would be very thankful for the effort." 

Then, again, a few views regarding the duties of the dental nurse: 

"The nurse who realizes the importance of having a place for 
everything and everything in its place, who watches supplies like a 
hawk and detects inferior products or overcharges, who keeps each 
day*s work up to its original standard, may feel that she i§ abso- 



ORAL HEALTH 351 

lutely essential to her employer. Surely not in an egotistical or self- 
satisfied way, but because he really needs her in the capacity of a 
nurse. Such a dental nurse is on the road to efficiency." 

This is a pretty high standard, and it is to be hoped that some 
means may soon be devised whereby nurses of this type may become 
available. 

Commercialism in Dentistry. 

Frequently writers in our dental journals grow enthusiastic in 
describing the efforts of a few practitioners who lay claim to unique- 
ness in that they do not hesitate to spend days or even weeks in per- 
forming operations ordinarily taking so many minutes or hours to 
complete. All the devices known to modern dentistry are requisi- 
tioned and made to pay tribute. Time and expense are obviously 
of little account, provided desirable results are obtained. 

Such men are working under ideal conditions, we say, and we 
envy them this distinction. Seldom, if ever, are we advised as to 
the amount of their remuneration. This would be a mixmg of the 
sublime with the ridiculous, and as such cannot be entertained. 
"There are no wealthy dentists" — such was often told us when we 
were students with a yearning to follow in the footsteps of the illus- 
trious. *'The only dentists who even approach the status of 'wealth' 
are those who have adopted unscrupulous methods in their practices" 
— this is a view that has even found expression in our dental litera- 
ture. 

The effect of such teachings — one is almost inclined to call them 
farcical teachings — is to engender in the minds of dentists a disre- 
gard for the monetary side of his labors. What a sad thing it is to 
see some members of our profession who, in their earlier years, gave 
unstintingly of their time and skill in advancing the cause of den 
tistry and are now without means of support. 1 hey are de{HMidcnt 
upon others for a livelihood. A pitiful spectacle, we say. and yet it 
ought to serve as an object lesson. There are two sides even to a 
professional career — service and reward. One is just as important 
as the other. 

Recognizing that a "laborer is worthy of his hire" it does not seem 
fair that we should charge as "commercial" those members of our 
profession who, while seeking new and better methods of dentistry, 
gather to themselves what is at best only a fair return for their labors. 
A dentist does not necessarily become "commercial" because of giving 
up his private practice to take part in the production of some article 
for the use of the profession. Such men deserve our help and sympa- 
thy and should not be discouraged by reason of our unjust censure. 
Dentistry needs, more than anything else, men who will do research 
work. Let us see that we survey the ground carefully before con- 
demning any of our associates. 



352 ORAL HEALTH 

Preventive Dentistry. 

A breezy, helpful little article occurs in Dental Review (June) 
by Dr. St. A. Chamberlain on methods to be employed in prevent- 
mg dental ailments. The author, in reviewing briefly modern methods 
of dentistry, shows how it is possible, even under the best conditions, 
to cause areas about the tooth that will be possible source of subse- 
quent infections. He holds to the view that the best dentistry is that 
w^hich will prevent the loss of tooth tissue. 

Taking into consideration the methods usually employed, the 
author shows how easy it is to bring undesirable conditions. In de- 
vitalization, if arsenic is used, the periapical tissues is attacked, its 
vitality is lowered, and it becomes susceptible to infection through 
the blood stream. If pressure anesthesia is used there is danger of 
infective material being forced through the apex. When treating 
putrescent root canals with strong drugs, the apical pericemental 
tissues suffer. The operation of filling root canals, unless free from 
sources of infection, will cause new troubles to occur later on. Crown 
and bridge work, either on vital or devitalized teeth, is attended with 
grave danger to the subject. In fact, no operation in dentistry, hav- 
ing in view the restoration of lost tissue, is above criticism. The best 
dentistry, then, is preventive rather than restorative in character. 

Now for the author's suggestions for the prevention of dental 
ailments. First, the patient is instructed as to a course of home 
treatment. He is advised **to equip himself with a proper tooth 
brush, one with the bristles arranged in tufts, and the length of the 
bristles graduating from the short bristles at the end to long ones near 
the handle. Inasmuch as it is the end of the bristle which does the 
cleaning, none of them should be so long that they bend while sliding 
the brush over the teeth. Start the brush on the gums and with a 
rolling motion sweep down over the teeth." Young patients are 
instructed to use dental floss and older patients to use the flat floss 
for polishing between the teeth. A saponaceous tooth paste is to be 
used and followed by a vigorous rinsing of the mouth with lime 
water. In extreme cases of caries and denuded roots the mouth 
cavity is to be swabbed with a solution of lodo-glycerol. "lodin 
has great penetrating properties as well as germicidal properties, and 
will penetrate the mucous plaques as well as deposits of fermenting 
foods." 

When the patient visits the office for treatment the first thing to do 
is to remove all calcareous deposits above and below the gingiva. 
The surfaces of the tooth are then polished with flower of pumice, 
usmg dental engine with cups and disks. Flat floss is used to polish 
the prominent surfaces "not only pass floss between the teeth, but 
polish the proximal surfaces carefully, flooding the field of opera- 
tion. Finish and spray, using compressed air." 



ORAL HEALTH 353 

An abrasive, applied with engine polishing brushes, is then used 
on the sulci and pits. After drying the tooth, the pits and fissures are 
flooded with 20*7r Ag No3 and worked in with a sharp explorer. 

"This should be dried, and either white or black copper cement 
worked into all the crevices, leaving as much on the occlusal surface 
of the tooth as is possible without interfering with the occlusion. This 
cement will gradually wear away, leaving the fine lines still sealing 
the weak places for a long period of time, when the same can be 
repeated." 



D 



n 



MVLTUM IN PAEVO 

This Department is Edited by 
C. A. KENNEDY, D.D.S., 2 College Street, Toronto 

HELPFUL PRACTICAL SUGGESTIONS FOR PUBLICATION. SENT IN BY MEM 
HERS OF THE PROFESSION, WILL BE APPRECIATED BY THIS DEPARTMENT 



D 



D 



■ Burning Out Wax. — Wax in a casting investment should 
never be burnt out with a very hot flame, causing the melting wax to 
boil up through the sprue hole. Avoid this and you will have smooth- 
er castings. — Robert /. Cruise, Chicago, III. (Denial Reviciv). 

Renewing Zinc. — When zinc that has been used for dies becomes 
thick and does not pour well, it is melted to dull red heat, and a 
tablespoonful of strong hydrochloric acid is added while stirring. 
Pacific Dental Gazette (Dental Cosmos). 

Removal of Rust From Instruments. — The rusted instru- 
ments are laid in a solution of tin chlorid, preferably hot, and after- 
wards rinsed in clear water. Abrasives remove the polish. /-.. /). 
Spears, Journal American Medical Association (Dental Cosmos). 

Sterilizable Washers For Hypodermic Syringes.- Washers 
to be used on hypodermic syringes are easily made out of block tin of 
desired thickness and are far preferable to leather washers, as they 
are durable and can be boiled when necessary. A/. M. Bron^n. 
Dental Digest (Dental Cosmos). 

Injecting Local An/esthetic Into An Abscess. One 
should not inject the anaesthetic solution into an abscess, for by doing 
so the septic material and organisms may be forced from their com- 
,;paratively benign location into the blood or lymph-stream and set up 
a similar pathological condition in other parts of the body. Dental 
Review. 



ACTIVE SERVICE ROLL 

Complimentary copies of ORAL HEALTH will be sent during the progress of 
the war to all Dental Graduates on active service whose army address is known. 



Ilfflnnr Snll 


MAJOR P. P. BBLLACHBY. 58th Batt. 


MAJOR C. E. SALE, 18th Batt., 4th Brigade. 


LIEUT. 11. J. McLAUUIN, 43rd Batt. 



CANADIAN ARMY DENTAL CORPS 



Lt. -Col. J. A. Armstrong. 
Major O. K. Gibson. 
Major A. A. Smith. 
Capt. J. W. Bell. 
Capt. C. Brown. 
Capt. J. F. Blair. 
Capt. G. N. Briggs. 
Capt. W. J. Bentley. 
Capt. G. S. Cameron. 
Capt. O. A. Elliott. 
Capt. E. A. Grant. 
Capt. W. R. Greene. 
Capt. George Gow. 
Capt. O. G. Hassard. 
Capt. J. E. Holmes. 
Capt. G. G. Hume. 
Capt. F. W. B. Kelly. 
Capt. H. Lionais. 
Capt. F. R. Mallory, 
Capt. A. E. Mullin. 
Capt. B. L. Neiley. 
Capt. E. B. Sparkes. 
Capt. G. H. A. Stevenson. 
Capt. W. G. Tirelford. 
Capt. L. N. Trudeau, 
Capt. C. F. Walt. 
tMajor W. B. Clayton. 



Capt. G. C. Bonnyeastle. 
Capt. F. H. Bradley. 
Capt. B. W. Brock 
Capt. C. D. DesBrisay. 
Capt. D. M. Foster. 
Capt. W. T. HaiOkeitt. 
Capt. W. Y. Hayden. 
Capt. F. W. Howe 
Capt. Jas. M. Magee. 
Capt. H. L. Mitchener. 
Capt. J. G. Roberts. 
Capt. H. A. Semple. 
Capt. S. H. Simpson. 
Lieut. J. T. Adams. 
Lieut. S. G. Alderson. 
Lieut. N. S. Bailey, 
liieut. J. A. Beatty. 
Lieut. F. C. Briggs. 
Lieut. F. E. Burden 
Lieut. T. W. Caldwell. 
Lieut. C. E. Campbell. 
Lieut. E. H. Campbell. 
Lieut. A. v. Cashman. 



Overseas* 

Capt. A. W. Winnett, 

Capt. J. E. Wright. 

Capt. W. W. Wright. 

Lieut. H. F. Alford. 

Lieut. G. Atkinson. 

Lieut. R. H. Atkey. 

Lieut. D. J. Bagshaw. 

Lieut. W. A. Burns. 

Lieut. G. H. Bray. 

Lieut. H. Clarke. 

Lieut. A. R. Currie. 

Lieut. G. H. Fowler 

Lieut. A. A. Garfat. 

Lieut. W. H. Gilroy. 

Lieut. D. H. Hammell. 

Lieut. J. W. Hagey. 

Lieut. H. C. Hodgson. 

Lieut. E. W. Honsinger. 

Lieut. E. C. Hutchison, 

Lieut. R. Jamieson. 

Lieut. J. L. Kappele. 

Lieut. E. J. Kelly. 

Lieut. O. Leslie. 

Lieut. A. G. Lough. 

Lieut. C. A. McBride. 

Lieut. W. G. MacNevin. 

Lieut. C. E. McLaughlin. 

Concentration Camps 

Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 
Lieut. 



H. R. Clevelana 


Lieut. 


E. H. Crawford. 


Lieut. 


Karl Damon. 


Lieut. 


J. M. Deans. 


Lieut. 


R. L. Dudley. 


Lieut. 


J. H. Dufe. 


Lieut. 


J. N. Dunning. 


LieoiL 


W. R. Eaman. 


Ltieiut. 


R. W. Fell. 


Lieut. 


H. B. Findley. 


Lieut. 


R. W. Frank. 


Lieut. 


J. P. Gallagher. 


Lieut. 


B. R. Gardiner. 


Lieut. 


G. E. Gilfillan. 


Lieut. 


J. S. Girvin. 


Lieut. 


S. S. Harvie 


Lieut. 


H. J. Henderson. 


Lieut. 


P. J. Healey. 


Lieut. 


F. Hinds. 


Lieut. 


H. A. Hoskim. 


Lieut. 


R. O. Howie. 


Lieut. 


G.H.HoUingshead. 


Lieut. 


H. C. Jeffrey. 


Lieut. 



Lieut. R. McMeekin. 
Lieut. B. P. McNally. 
Lieut. E. McNeill. 
Lieut. H. C. Macdonald. 
Lieut. J. W. Macdonald. 
Lieut. E. D. Madden. 
Lieut. V. C. W. Marshall. 
Lieut. L. L. Matchett. 
Lieut. G. V. Morton. 
Lieut. J. F. Morrison. 
Lieut. J. B. Morison. 
Lieut. C. H. Moore. 
Lieut. P. E. Picotte. 
Lieut. H. Ross. 
Lieut. J. Roy. 
Lieut. W. A. Sangster. 
Lieut. J. F. Shute. 
Lieut. D. P. Stratton. 
Lieut. R. C. H. Staples. 
Lieut. E. S. Tait. 
Lieut. L. A. Thornton. 
Lieut. H. P. Thompson. 
Lieut. H. P. Travers. 
Lieut. D. D. Wilson. 
Lieut. Karl F. Woodbury. 
Sgit. R. J. Godfrey. 
Sigt. E. F. Jaimieson. 



C. M. Joyce. 
Frank Knight. 
L. Lemire. 
T. H. Levey. 

C. C. Maclachlan. 
H. C. Mann. 

e. p. MarloAt 
W. Mas on. 

D. W. Massey. 
H. A. MciCrea 
W. J. McEwen. 

E. F. McGregor. 
D. K. Mcintosh. 
J. M. Mclntyre. 
W. S. McLaren. 
W. H. McLaren. 
L. D. McLaurin. 
G. A. Munroe. 
Otto Nase. 

J. G. O'Neil. 
R. M. Peacock. 

F. H. Quinn. 
W. H. Reid. 



tActing Director of Dental Services, address Ottawa. *Lieutenants rank as 
Captains while overseas. C.A.D.C. overseas address — Care Director Dental 
Services, Canadian Contingents, 23 Earls Ave., Folkestone, England. 



of CANADIAN DENTISTS 

OUAL IlKALTH will appreciate roceivinK "»'"<'« Jind addresses or other in foriuat ion ihat will make th<*s(> 
pages a eouiplete Army Service IJireetory consiantly available to every iiirintxT <>f th<- |.r..f <••.'*,. in 









Concentrati 


an 


Camps. — (Cont 


nued.) 








Lieut. 


J. 


W. 


Reynolds. 


Lieut. 


AV 


'. G. Switzer. 


Lieut. 


G. 


A. 


Wilcox. 


Lieut. 


T. 


E. 


E. Robins. 


Lieut. 


A. 


J. Thomas. 


Lieut. 


F. 


M. 


Williamson. 


Lieut. 


J. 


A. 


Ross. 


Lieut. 


E. 


L. Thompson. 


Lieut. 


E. 


H. 


Wil.son. 


Lieut. 


W 


J. 


Rutherford. 


Lieut. 


A. 


E. Wark. 


Lieut. 


J. 


H. 


Wiltze. 


Lieut. 


H. 


A. 


Simmons. 


Lieut. 


B. 


L. Washburn. 


Lieut. 


C. 


E. 


Wright 


Lieut. 


H 


A. 


Stewart. 


Lieut. 


V. 


D. Wescott. 


Lieut. 


E. 


K. 


Zimmerman. 


Lieut. 


J. 


A. 


Stewart. 








Lieut. 


J. 


H. 


Zinn. 



Capt. T. C. Bruce. 
Capt. A. Dubord. 
Capt. H. T. Minogue. 



Divisional Officers 

Capt. F. P. Shaw. 
Capt. Geo. K. Thomson. 



Capt. W. G. Thomp.«?on. 
Capt. F. M. Well.s. 
Capt. J. M. Wilson. 



ATTACHED TO CORPS OTHER THAN C.A.D.C. 
Overseas 



Major G. S. Came^ron, 9th C.M.R. 
Major F. T. Coghlan, 25th Battery. 
Major Chas. A. Corrigan, Army Ser- 
vice Corps. 
Capt. K. C. Campbell, 43rd Batt. 
Capt. J. R. Duff, 79th Batt. 



Capt. J. Harper, Royal Navy. 
Capt. J. L. McLean. 59th Batt. 
Capt. Walter McNallv, 179th Batt. 
Capt. S. J. Redpath. 47th Batt. 
Lieut. A. R. Leggo. 58th Batt. 
Staff Sgt. J. G. Roberts. C.A.M.C. 



Concentration Camps 

Lieut. Col. B. F. Armstrong, 159th 

Batt. 
Lieut. -Col. Neil Smith, 181st Batt. 
Major H. A. Croll, 10th C.M.R. 
Major N, Schnarr, 94th Batt. 



Capt. A. L. Johnson, 68th Batt. 
Lieut. A. J. Kennedy. 114th Batt. 
Lieut. C. Nichol.<;on. 12:»th Batt. 
Lieut. T. H. Renton. 14»:tli Batt. 



Lieut. R. M. Barbour, 

64th Batt. 
Sgt. E. G. Berry. 
Sgt. T. D. Ca,mpbell. 
Sgt. H. R. Conway. 
Sgt. H. C. Goodhand. 
Sgt. J. C. Livett. 
Sgt. G. R. McMillan. 
Sgt. J. H. Reld. 



UNDERGRADUATES 
Overseas 

Sgt. H. L. Sin i 111. 
Sgt. W. J. Taylor. 
F. H. Barry, C.A.D.C. 
A. Chambers, C.A.D.C. 
E. R. Dixon, 71.st Batt. 
E. Garfat, 71. st Batt. 
J. E. Irwin, C.A.D.C. 
J. T. Irwin, 4th V. of T. Co 
A. W. Jones. C.A.D.C. 
J. V. Lally, C.A.D.C. 



J. G. Larmour, (\F. .\. 
H. B. Legate. C.V.D.C, 
W. C. Legett. C.A.D.l'. 
E. S. McBride. C.A.D.C. 
R. B. McGwire (Briti.sh 

Corps). 
T. E. Walker. C.F.A. 

A. Walton, C.A.M.C. 

B. Watson. C.A.M.C. 



Concentration Ca 

W. G. Alston, 67th Battery. E. C. 

H. R. Anderson, 67ith Battery. J. M. 

H. G. Bean, 198th Batt. Win. 

R. Bishop, C.A.D.C. E. (\ 

R. T. Broadwortih. 67th Battery. C. T. 

A. G. Calbecik. 67tih Battery. G. S. 

A. E. Chegwin. 198th Batt. A. L. 

F. Cluff. 161st Batt. C. T. 
O. G. I^Kailii-yiniple. 67th Ba;ttery. A. R. 
E. N. Elliott. C.A.D.C. W. A 
R. W. Freestone, 67th Battery. C. C. 
H. Greenwood, 76th Batt. Tl. G. 

G. E. Harper. C.F.B. W. E. 
G. M. Heisz. Div. Sig. Corps. G. .\. 
A. S. Holmes, Div. Sig. Corp.s. C. H. 
G. W. Howson, 126th Batt. W. H 
T. H. Hutchinson. C.A.D.C. W. L 
J. T. Irwin. 4th TT. Co. V. D. 
G. G. Jewitt, Field Amb. C. W. 
A. N. Laidlaw, Mach. Gun. F. L. 



mps 

.McKee. C.X.D.C. 
McLood, Div. Sig. Corps*. 
M.u-kaok'. 67th Rattory. 

McKec. l\.\.l>.C. 
Mrnle. 67th U,'»ttt»r>'. 
MxiVr.av. Annv Trnn.iport. 

Norton. (\.\.I).C. 
rnrkor, CADC. 

I'oag. C.A.D.C. 
. Porter. C.A.M.C. 
Rnmaifp. C.A.M.C. 

Held. Me«hanic«I Trnn-sp 

Shorriil.'in. r.7th Itnttory. 
Sirr.'s. .\rinv Tr.ui.'»port. 
Shvui. .'^Oth Batt. 
. Smith. 160th R-itt. 

Smith. Div. Sl»f. Corp.-*. 
SptHT, 67th Bftttory. 
Steoh'. 67th B.nttivry. 
Thomp-^on. C.A.D.C. 



•It 



A"S 



easonaoie 



bi( 



Letter From One of the Editorial 
Staff. 



[ With the thermometer registering about 90 in the shade, 
the follorving letter arrived at the Editor's desk ^ik^ ^ ^^ol 
welcome breeze from the Northern wilds. Every dentist 
requires a period of midsummer rest and recreation if his 
greatest asset — his health — is to be preserved. Lock ihe 
office door and take that holiday youve been thinking 
about. It will repay you many times over, smooth out the 
kinks, and fit you for rendering better service to your patients 
upon your return. — Editor.] 




Idyl Pynes, Georgian Bay, 

July 18, 1916. 
My Dear Doctor Seccombe: 

I have been "a-goin* " to write you for a week, but have been so 
busy doing many things that my correspondence has been seriously 
neglected. I trust you are not suffering too much from the effects of 
Old Sol, as I hear none too good reports about his capers in our 
good city. We made a good journey to his northern home, and I 
assure you it was quite a relief to get your feet on the pine needles 
once more and get rid of all surplus clothing. Here I am at 9 a.m. 
with coat, collar and hat cast aside and feeling like a native, and 
my wife says looking even worse. I got out the first morning exactly 
with the sun and had the launch in commission before breakfast. 
That seemed to be too much of an effort and have not been guilty 
of such recklessness since. We found the cottage opened up and 
ready for us, and everything inside pretty well preserved. The only 
catastrophe of profound gravity was that a mouse made a comfort- 
able nest in the waist-^band of my fishing trousers — an unpardonable 
offence — and it has been "war to the death" ever since. 



ORAL HEALTH 357 

Haven't done much fishing as yet. Been too hot for success in 
that line. Still a little niece and I went out yesterday a.m. and she 
landed a fine chap — enough for dinner for six. I see she is writing 
her daddy a graphic account of it just now. I find plenty to do 
around the cottage. What with hunting enough to keep the house- 
hold from being hungry and keeping things in order, I don't think 
there is much danger of getting too fat or lazy. 

Most sincerely, 

R. G. McLaughlin. 



Oral Hygiene Reports. 



Nero York City, N.Y. — Nicholas Murray Butler, president of 
Columbia University, yesterday appealed for a fund of $ 1 ,000,000, 
yielding an annual income of $50,000, for the proposed dental school. 
Such an endowment will be necessary to found and maintain the 
school in conformity with the high standards set for it. A dispensary 
where treatment to the poor will be provided is planned in the school. 
The course will be four years, the first two identical with the medical 
course. 

Long Island City. — Dr. J. Chester Haynes, assistant superintend- 
ent of St. John's Hospital, in Long Island City, has announced that 
on June 1 children living in Corona, Woodside and Astoria may 
have their teeth attended to free of charge. Dr. Haynes, in order 
to raise $1,000 needed to buy instruments, has interested a number 
of wealthy residents of Astoria, who have promised to give the 
money. 

Fargo, N.D. — At a meeting of the Commons Club, held at the 
Gardner Hotel, Fargo, resolutions were adopted authorizing the 
president to appoint a committee of three to draft a new law or 
amend the present state medical inspection law with a view of put- 
ting it before the State Legislature at its next session, in order to bring 
about compulsory oral hygiene in the public schools of the state, and 
that the club would lend its support to the Fargo School Board to 
promote better conditions of oral hygiene in the i)ubhc schools of 
the city. 

San Francisco, Ca/.— In support of a cami>aign now carried on 
by the San Francisco Congress of Mothers for the establishment of 
free dental clinics in the public schools, a series of motion pictures 
will be shown in a number of theatres. The pictures show the urgent 
needs of the schools and the work already accomplished in Garfield 
and Visitacion Schools, where dental chairs are now in operation. 
An appropriation of $5,000 is provided in the next budget for dental 
purposes, and the Mothers' Congress will go before the Supervisors 
to urge its passage. , ., ,*! . 



I ORAL HEALTH 



(ZZI 



EDITOR 

WALLACE SECCOMBE, D.D.S., Toronto, Ont. 

CONTRIBUTING EDITORS 

GEORGE K. THOMSON, D.D.S., Halifax, N.S. 
F. W. BARBOUR, D.D.S., Fredericton, N.B. 
ASHLEY W. LINDSAY, D.D.S., Chengtu Sze Chuan 
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y. 
T. W. WIDDOWSON, L.D.S., London, England. 
J. E. BLACK, D.D.S., Vancouver, B.C. 
MANLY BOWLES, D.D.S., Winnipeg, Man. 
J. A. C. HOGGAN, D.D.S., Richmond, Va. 
EDGAR D. COOLIDGE, D.D.S., Chicago, III. 
RICHARD G. Mclaughlin, D.D.S., Toronto. 



Entered as Second-class Matter at the Post Office, Toronto. Sub- 
scription Price: Canada, $1.00; Other Countries, $1.25; Single Copies, 25c. 

Original Communications, Book Reviews, Exchanges, Society Reports, 
Personal Items and other Correspondence should be addressed to the 
Editor, Oral Health, 269 College St., Toronto, Canada. 

Subscriptions and all business communications should be addressed 
to The Putolishers, Oral Health, 269 College St., Toronto, Canada. 



Vol. VI. 



TORONTO, AUGUST, 1916 



No. 7 



H 



E D I T O R.I ALi 



H 



The Dental Hygienist and Preventive Dentistry. 



THE movement to train young ladies to clean and polish the sur- 
faces of teeth, and legalize their performance of this work, has 
met with some degree of favor in certain localities. This we 
believe to be a mistake and quite inimical to the best interests of the 
public and dental profession. In its support the sponsors for the 
movement claim the urgent need for oral cleanliness and a pubHc 
requirement for services which cannot be supplied by the dental pro- 
fession at the present time. 

We must bear in mind that oral health means something more 
than the periodic visitation to a dental office for prophylactic treat- 
ment. Possibly the greater element entering into the prevention of 
dental diseases will be found to be the daily conduct of the indi- 
vidual concerning those habits of living that make for general health 
and the proper dail^ care of the mouth. Any movement that in any 
way tends to shift the responsibility for cleanliness from the indi- 
vidual to some other person — whether it be dentist or so-called 
hygienist — is decidedly a retrograde step. 

People must be educated to take the necessary time to keep their 



ORAL HEALTH 359 

mouths clean and healthy. The ordinary individual realizes that he 
must keep his body in a clean and hygienic condition and quite will- 
ingly assumes the burden. And why not the mouth? Under mod- 
ern conditions of living oral cleanliness has assumed a most important 
position. The technique of cleansing requires much more time than 
the average individual now gives to that task. A great many, 
through ignorance of the subject or through a lack of appreciation of 
its importance, neglect the hygiene of the mouth completely. The 
solution is public education and instruction — particularly in the 
schools. What the dentist needs more than the co-operation of the 
suggested professional hygienist is the co-operation of the individual 
patient The dental hygienist idea might, however, appeal to the 
"idle rich" — if there be such — who may be too idle to clean their 
teeth and rich enough to pay the hygienist to perform that personal 
service. 

We venture the opinion that if the individual give proper exercise 
and proper care to his teeth, he will require very little special pro- 
phylactic treatment, and, in the majority of cases, develop an immun- 
ity to dental disease. 

If these young women are to give prophylactic treatment, includ- 
ing oral hygiene instruction, the examination of the mouth will be 
naturally included, and this in turn will naturally lead to the giving 
of advice. The patient will thus be deprived of the services of the 
dentist in some of the most important phases of dental nractic?. It 
seems almost incredible that there are those in the profession who, 
having regard to the best interests of their patients, would be satisfied 
to allow such conditions to obtain. 

The oral hygienists of Connecticut recently held a convention, the 
programme of which, it was reported, "would do credit to any dental 
society, the principal address being delivered by Dr. F. C. Noyes 
upon the subject of the peridental membrane." Some rapid pro- 
gress (?). But how can prophylaxis be intelligently performed with- 
out a knowledge of the histology of the tooth and the surroundmjj; 
parts. How can prophylaxis be intelligently performed without an 
intimate knowledge of dental anatomy and the many pathological 
conditions found in the mouth? 

A young lady trained as an efficient assistant to the dentist in the 
operating room renders most valuable aid to the dental surgeon and 
increases output of service materially. In place of schools for dental 
hygienists, we should have schools for dental assistants, so that there 
might be available to every dentist a trained assistant who would be 
^'an extra pair of hands," and enable the dentist to better meet the 
demands that are made upon him. If dentists sto[>ped puttering in 
the office over the hundreds of little things that could be better done 
by a trained assistant, there would be ample time for the more im- 
portant services, namely, prophylaxis and instruction. 



Canadian Dentists at the Front. 



THE dental profession is greatly honored by its many members 
who have donned khaki. It is with feeHngs of pride that we 
remember those who have closed the office and given up com- 
fort, home and friends that they might take their place in the world 
war for liberty and freedom from Prussian militarism. Canadian 
dentists represent the profession in the Dental Corps and other 
branches of active service in a most unselfish and heroic way. 



British Dentist Honored by King. 

FRANCIS MARK FARMER, member of the dental profes- 
sion, England, was recently created a Knight, because of ser- 
vices rendered to the British War Office as a dental surgeon. 
Congratulations, Sir Francis. 



Oral Hygiene Reports. 



Boston, Mass. — An evening dental cHnic is to be started by the 
Boston dispensary. An evening session has been decided upon on 
account of the great need of dental service to working people who 
cannot attend during the day. 

San Francisco, Cal. — Dentists are to be in attendance at the pub- 
lic schools at the beginning of the next school term. The Board of 
Education has set aside the sum of $3,000.00 to meet the expenses 
of a school dental clinic. Drs. Eggert and Hill have been appointed 
school dentists, with Miss Faville as assistant. 

Macon, Ga. — At the recent meeting of the Georgia State Dental 
Society the plan was unanimously endorsed of having a bill intro- 
duced at the next session of the Legislature providing for the appoint- 
ment of two dentists as State Dental Inspectors, their duties being 
to give regular and specified instruction to the school children of the 
state on the value and care of the teeth. 

Washington, D.C — The National Capitol Dental Society has 
fyled a recommendation with the district commissioners that the latter 
include an estimate of $5,000.00 in their next budget for the estab- 
lishment of two dental clinics for school chilcjreji. . N. M. Dolmadge, 
chairman of the Oral Hygiene Committee, stated that seventeen 
states and thirty-two cities have free dental clinics for the poor, gov- 
ernmentally supported and connected with the, school system. The 
Superintendent of Schools an^ the Boar^.Q-f Education ;have endorsed 
the proposed expejiditure. .^ .'. ;^ J.. , .. , .. 



The Law of Habit 

TTABIT is simply a matter of 
-*--■- mathematics. In other 
words, all that is necessary to get 
into the habit of doing a certain 
thing is to do it often enough. 
This law applies to good habits 
just as much as to bad ones. 

To become a man of clean hal)its 
and strong, wholesome life, all 
one has to do is to keep doing 
clean, strong, wholesome things 
long enough. Of course, to do 
that is where the rub comes : but 
it will surely help a great deal to 
remember that the Creator piil 
an instrument of good in our 
hand when He made that baw ol 
Habit. _s,ir,ttMi. 




Lieut. Howard James MacLaurin 

Winnipeg 

Fell while bravely leading his men 
in a charge to regain lost trenches 
June fourteenth, Nineteen-sixteen 



Bff 



m 



^m 



OPAL HEALTA 

A JOURNAL THAT STANDS FOR THE ** OUNCE OF 
PREVENTION," AS WELL AS THE "" POUND OF Cl'RE~ 



D 



VOL. 6 



TORONTO, SEPTEMBER, 1916 



No. 9 



Health, Dental Science and Efficiency. 



By a Contributor. 



IT is indeed praiseworthy that so much of time, investip^ation anri 
effort has been expended by men of our profession to minimize 

the dental imperfections of humanity, and to reduce discomfort 
in connection with the restoratives of same. At the same time it is 
well not to fail to give the dentist himself due consideration. 

Undoubtedly the man who is physically and mentally alert and 
capable is likely to render his best service, and so when due care is 
emphasized as incumbent upon the operator it is not wholly with 
selfish intent, but is quite directly for the benefit of his j^atients. 

It is generally recognized that the exi:)ectation of life on the jiarl 
of the dental profession is less than that of any other. 1 lie proportion 
who continue in harness till advanced years is remarkably small. 
The reasons are not difficult to point out. The sedentary employ- 
ment, the strained positions, and the inhalation of impurities arc 
physical reasons. Mentally, there is a strain of effort to do one s 
best when inflicting pain and discomfort, and the dram upon one s 
sympathies, and sometimes upon one's good nature, as the various 
temperaments of the afflicted are exhibited. 

It is easy, therefore, to ascribe causes for the more rapid running 
down of the dentist's machinery, but not so easy it may be to sug- 
gest means of overcoming these conditions. 

The object of these lines is to direct more attention to the preserva- 
tion of one's health and comfort, and to see if there are not ways bv 
which much of the harmful conditions can be ameliorated or 
relieved. 

In these days when people are awaking to their needs as related 
to dentistry, and so much is being learned by our profession as to 



364 ORAL HEALTH 

ways and means as to prevention and cure, there is no doubt but 
that the sense of responsibility on our part is becoming more and 
more impressive, and it is hopeless to do, as individuals, all that is 
demanded in every phase of work. The call to this service can 
surely not be best fulfilled by plunging in heedlessly to accomplish 
the impossible, and thus doing ineffective and probably short-lived 
service. It is rather by deliberately selected and carefully executed 
work that of itself will stand effectively, leaving the operator better 
satisfied with himself, and bringing about as little as possible of that 
mental and physical exhaustion which renders his future effort less 
serviceable and shortens the period of his calling. 

One of the ways in which the operator's life may be eased is by 
securing the confidence of his patient. If the latter can be duly 
impressed with the fact that you know your work (not by your 
telling him so, but by manner and action), if he can be brought to 
believe that you are giving every possible consideration to his good, 
then there comes that harmony that assists both to relax and be 
restful. 

If such a feeling cannot be engendered it is often unwise to pro- 
ceed at all. There are times when a barrier of antagonism seems 
to exist, and if it cannot be changed either at the time or in anticipa- 
tion of a later sitting, then it is better for all concerned that a change 
in the operator should be made. It is true that there are some indi- 
viduals that angels themselves could not associate comfortably with, 
but there is more often the fact that the lack of harmony exists when 
certain temperaments antagonize. 

It is well for a dentist to so arrange his appointments that opera- 
tions of the more exhausting character will not follow one another, 
and that so far as possible these should be undertaken during the 
hour of the day that finds him with energies alert and unimpaired. 
The position of the operator is important. Fortunate is the man 
who is ambidextrous and is not confined to the necessity of so con- 
tinuously retaining that posture that cramps the heart and brings too 
rapidly the stoop to the shoulders. Numbers of men use the mouth 
mirror and the angle hand-piece too little, and so are resorting to 
positions that involve unnecessary muscular strain. 

The young man, not yet too rigidly confirmed to habit, should 
cultivate the use of an operating stool. It seems very difficult for an 
older practitioner to cultivate its use. 

Outside of the direct relation to the patient, the surroundings of a 
dentist add largely to his comfort and his sense of ease in his work. 
So many of his hours are spent within his office walls, that so far as 
he is able his rooms should be bright, cheerful and comfortable. A 
sufficient number of rooms should be at his service to handle every 
phase of his work, and that of his staff, in a convenient manner. 

His lady assistant should be instructed in such a way as to be 
capable of relieving him of very many of the business dealings with 



ORAL HEALTH 365 

his callers, and she should have an office with an equipment which 
would care for most of these calls, and also afford opportunity for 
all secretarial work. With such an assistant capable of bookkeep 
ing, arranging appointments and looking after supplies, much of 
the laborious and often annoying effort is transferred to others. 

The assistant at the chair can be made an important aid in re- 
lieving oneself of simple, but necessary details. 

The appointments of the operating room should not necessarily 
be ostentatious or too manifold. Simplicity, with effectiveness, is 
more soothing to the patient and just as serviceable to the operator. 
The ready access to the needed article and an outfit which will mo5t 
readily supply the applicable instrument will save in the end a 
remarkable amount of time and effort, and will facilitate the opera- 
lion and enhance the patient*s comfort. 

Outside of his actual work, the dentist will find much of assist- 
ance, by the preservation of an open mind to the results of the labors 
of others as conveyed in publications or demonstrated at profes- 
sional gatherings. 

The pleasure of contact with our fraternity and the inspiration 
that each has the power to give, is always a delight, and surely gives 
a stimulus that is at once a relief from daily toil and an aid to 
future effort. 

Grey hairs, or the lack of them, should not be an evidence of 
slipping down hill; but clearness of mind, steadiness of hand will 
be the gauge of a man's age and fitness; for in denti^^try, surely. 
*'a man is as old as he feels." 

The number of hours in a day that should be engaged in labor 
is impossible of definite statement. The danger line should be care- 
fullv watched for and restrictions put on early. 

The value of vacations, air, exercise, and good food, with sufficoMt 
time to properly eat it, need only to be mentioned to be recognized 
as important. 

One thing that at first thought might seem contrary to the intent 
of this paper, but is really entirely in accord, is the real value of 
lending d'rect assistance to outside interests. At all tmus there are 
social, philanthropic and political interests that should ai^pcal for 
our co-operation. At the present time there are the calls of patriot- 
ism, as evident in Patriotic, Red Cross and recruiting agencies. Ilie 
response to such means not only defin'te assistance, but reacts on 
the worker to an extent that is very beneficial. 

To sum up in a word, it may be said that the man who can biip« 
about those conditions in self and surroundings, which will make 
work enjoyable and satisfving: who will know when to ease up and 
when to refrain, and will take advantage of the everyday onnor- 
tunities for culture, social service and physical refreshment, will Ho 
the most beneficent service and live the most comfortable profcj. 
sional life. 



The Importance of Correct Posture, with Especial 
Reference to the Use of the Feet. 



C. Stewart Wright, M.D., Toronto. 



[In this article Dr. Wright discusses a question seldom 
considered h^ the average dentist, and "^et one of vital 
importance to ever]) dental practitioner. It is generally 
recognized that members of the dental profession are par- 
ticularly susceptible to foot-trouble and shoulder-stoop. 
Read Dr. Wright's article and endeavor to maintain '*cor- 
rect posture at the chair." — Editor.] 

IN considering for a few minutes some points relative to the import- 
ance of correct posture, I believe we may, with advantage, start 

at the ground and work up, though I believe this topic usually 
conveys to the mind a consideration of the body only. 

We will, therefore, direct our attention first to a consideration of 
the correct use of the feet. I may state at the outset that the great 
majority of people toe out too much. This is probably because, as 
a race, we have been taught to do so. Until recently our military 
and school drill taught us so, and the ordinary footwear is usually 
designed to influence us in that way. 

All have heard the expression, "he is pigeon-toed," or "he walks 
like an Indian," derisively applied to one who assumed in walking 
or standing a posture which I hope to show more nearly approaches 
mechanical efficiency than does the attitude so commonly assumed. 

The child who uses his feet with the intoe posture is constantly 
teased by other members of the family and constantly corrected by 
the parents. In fact, in my capacity as a surgeon, whose attention 
is largely devoted to dealing with deformities of various kinds, it is 
not infrequently that I am consulted by anxious parents about a child 
who happens to walk in this manner. 

Since I have made this statement that most people toe out too 
much, I will endeavor to demonstrate why it is so. 

In considering the use of the feet we will have to include a brief 
consideration of the knee and ankle joints as well as those of the 
foot proper. 

As you know, the knee is a hinge joint having practically only a 
back and forward movement. The ankle joint is similar, having 
only a back and forward movement. The next point of movement 
of any appreciable degree in the use of the foot is at the metatarso- 
phalangeal joint, or where the toes join the foot, and these again 
are in the same plane with a back and forward movement only. It 
will be further noted that this small row of joints from within outward 



ORAL HEALTH 367 

angle backward about 20 degrees from a straight line or correspond- 
ing to the usual wrinkle of the shoe at that point. With these three 
sets of joints acting in the same plane and having the same type of 
motion, it follows that they would act in nearly a straight line, and 
properly used, they do. 

Now it will be found that if the foot is placed gently down, and 
the knee and ankle bent as in the act of walking, if it is performed 
with the greatest ease and without strain or twist of the knee or 
ankle, the knee will or should fall directly over the great toe 
(charging). 

At the same time all the toe joints are brought into use in bending 
the foot further forward, each bearing its portion and assisting in 
distributing the weight. 

Now if we grant, and we must from an anatomical study of these 
joints, that to avoid strain they should be used in this way, it follows 
that if the feet are everted or turned out and in the act of walking 
one adheres to correct principles as regards the use of the knee, ankle 
and toe joints, then progress must be made by a zigzag course, which 
would be very awkward indeed. 

But you will say people do not walk that way even though the 
feet are turned out considerably. Then how is the appearance over- 
come. First, by a little twisting and strain at the knee, a little more 
on the ankle, next on the arch of the foot; then instead of bending 
on the five toes all the weight of progression in the foot is carried on 
the great toe joint, instead of being evenly distributed over the five 
toes, and the general line of weight bearing, which is in line with the 
shin bone, is carried to the inner side of the foot instead of to its 
centre. 

This results in a constant overwork and injury of the great toe 
joint, and is the greatest single factor in producing the ever present 
bunion, or at least an enlarged and tender joint. It effects a weak- 
ening of the ankle and overstrain and breaking down of the long 
arch of the foot, producing flat foot and sometimes weak and pain- 
ful knees. Some very stout individuals who are entirely unable to 
stand this modified strain do actually assume the /ig/ag gait men- 
tioned above, and I am sure every one has observed this gait on 
the street. 

In different individuals there may be great variations in the 
amount of suffering sustained in the different joints: ()uite frequently 
painful knees may be entirely relieved by adopting a correct use 
of the feet. 

The most frequent location for suffering. houevtM. is in the long 
arch, due to overstrain and the production of flat feet. 

However, this is a problem which involves more than the con- 
sideration of the detrimental influence on individual joints and 
muscles, but it is relative to the whole question of the conservation of 



368 ORAL HEALTH 

the energy and the maintenance of the posture of the body as a 
whole. Not only do the immediate joints suffer, but as a conse- 
quence the whole organism. 

The lassitude and fatigue experienced by many after moderate 
exertion, or after a walk which ordinarily should result in improved 
vigor, may often be traced to such an attitude in the use of the feet 
as that described. 

Backache, headache and other suffering often result from such a 
waste of the available energy, for no part of a machine so delicately 
adjusted as the human body can be allowed to go wrong without 
the whole organism suffering. 

If, then, there are such disadvantages in the position described, 
what is the correct position. To help us determine that I wish to go 
to nature for assistance. The young child, before its feet have been 
influenced by shoes, walks with the foot in a straight line. The 
Indian, in the original state, as you know, held the feet in a straight 
line or slightly inward. 

Now, if instead of holding the foot turned out as mentioned, we 
bring it into a straight line ahead, it will be observed that when the 
knee and ankle bend they do so with the least effort; the five toes 
bend in the motion of the foot, and the line of weight bearing falls 
directly through the centre. 

This leads us to a consideration of the importance of correct pos- 
ture of the body. Raise the chest just as high as possible without 
raising the shoulders. Make an effort, in fact, to hold the shoulders 
down. Do not throw the shoulders back or make any effort to draw 
the abdomen in, simply raise the chest and the result will bring the 
spinal column into position and raise all the vital organs to their 
normal height. 

I do wish, however to point out that due attention to the facts 
presented regarding the correct use of the feet will have a very 
important bearing upon the ease with which one will assume and 
maintain a correct posture of the body. Certainly, if the foundation 
is at fault the superstructure must suffer. 



German Dentists and the War. — About 1 ,400 German den- 
tists have been summoned for war service up to October, 1915. Of 
this number, 900 are among the first line troops serving as soldiers or 
officers. About 500 are doing dental or medical duty in hospitals, 
and of these again more than 300 are assigned to field and base hos- 
pitals, while some 180 are giving dental service in their home cities. 
Up to October, 1914, 130 dentists had been killed in action, while 
considerably more than eighty were wounded and eleven made pris- 
oners.— Oes/erverc/ifsc/i, Ungarische, Vierteljahrsschritt fur Zahn- 
herlkunder, per Dental Cosmos. 



The Microscopic Examination of Finger Nail Deposits. 

Significance in Forensic Medicine and in Public and Personal 

H\)giene. 



Albert Schneider, Ph.D., M.D., San Francisco. 



[The danger of infection from finger nail deposits is 
clearly shown by Dr. Schneider. The subject is of special 
interest to the practising dentist. No thoughtful man could 
read the article without appreciating the importance of giving 
particular care to the cleansing of the hands and special 
attention to the condition of the finger nails. — EDITOR.] 

THE microscopic examination of the deposits under the finger 
nails promises to be of importance in forensic medicine and also 
in certain phases of public sanitation and personal hygiene. 
This form of examination has been known for some time, and has 
been practically applied in a number of criminal cases both in this 
country and in Europe, but so far it has not been adopted as an 
officially recognized routine in the examination of criminals or those 
suspected or accused of having committed certain crimes. 1 he possi- 
bilities of this procedure became apparent to me over twenty-five 
years ago when incidentally examining the scrapings from my own 
finger nails and those of my laboratory assistants. The number and 
variety of substances found was astonishing. Since that tinio the 
microscopic examination of finger nail deposits has been made a 
laboratory exercise for students in connection with the study of fiber 
and of body cells and bacteria. 

This particular exercise was at first sandwiched in as a diversion 
rather than a part of the regular course. Each student of a class of 
forty or fifty was requested to mount the scrai)ings from the nails of 
the second and third fingers of the right hand (in case of right handed 
persons) on a slide in a drop of water and to examine this carefully 
under the high power (450 diameters) of the compound microscope. 
The findings proved interesting and not infrequently astoni.shing to 
the student. The most important part of this laboratory exercise was 
the interpretation of the findings. The findings gave evidence of the 
routine labors engaged in for periods of from one to eight days previ- 
ous, and of the personal habits, of the kind and quality of clothing 
worn, of business occupations, etc. 

It was found that there was a very notable difference in the con- 
tents of the deposits of the nails of the right and Kft hands, and also 
m the deposits of the nails of fingers and thumb of the s.inir hand. 
Numerous examinations proved that the ordinary methods of clean- 



370 ORAL HEALTH 

ing the hands by means of soap, hot water and clean towel, inclusive 
of the usual nail trimming and polishing, as observed by persons of 
clean and sanitary habits, does not materially alter the microscopic 
findings; in other words, the usual hand toilet operations do not clean 
the hands and certainly do not cleanse the inner surface of the free 
ends of the finger nails. Even the vigorous use of the nail brush with 
soap and hot water does not result in a removal of all the deposits. 
Of far greater influence is the habitual close trimming of the finger 
nails as observed by some persons. If the nails are regularly trimmed 
very close, to the point of nearly causing bleeding, very little deposit 
of any kind will find lodgment. This practice is rare, however, and 
may be considered the exception to the rule. 

The bacteriologic findings of the finger nail deposits are also very 
interesting. The streptococcus group apparently predominates in 
most persons, rather than the staphylococcus or the colon bacillus 
group, as one might reasonably expect. The organisms found in the 
rather limited number of cases (143) examined predominate in the 
following order: 

1. Streptococcus group, the acid fats varieties predominating. 

2. Staphylococcus group. 

3. Bacillus coli group, almost invariably present. 

4. Bacilli, cocci and spirillae probably derived from mouth, soil, 
food, water, body surface, nose, eyes, sewage, dust, dirt, etc. 

5. Occasional yeast cells, spores and filaments of higher fungi. 

6. Larvae of vermes; occasional amebas; diatoms, algae; etc. 
From the medicolegal standpoint, the examination of nail deposits 

will prove of greatest value in those criminal acts in which great 
violence is employed, as in murder, physical encounters of all kinds, 
and rape or attempted rape. In such cases it would be desirable to 
examine the nail deposits of both the accused and the accuser, for as 
is known, persons are not infrequently falsely accused, and particu- 
larly is this true in charges of rape or attempted rape. For example, 
scratches and other skin abrasions on hands and face of the accused 
should reveal skin epithelium, dermal fragments, blood corpuscles and 
possibly hair fragments of the accused in the nail deposits of the 
victim. If such findings proved wholly negative, especially in the 
absence of marked injury to the genitalia of the accuser, it would 
point to either false accusation or perhaps voluntary submission. 
Valuable evidence may also be obtained in other criminal acts. A 
husband was accused of having induced his wife to submit to the 
performance of criminal abortion and to have disposed of the fetus. 
The examination of the husband's finger nail deposits revealed a 
number of frustules of fresh water diatoms and a few filaments of 
oscillaria which led to the suspicion that he had buried the fetus in 
some marshy soil. Careful search along the marshy edge of a nearby 
stream revealed no newly-made grave, but a slightly scooped out 



ORAL HEALTH 371 

depression in the edge of the stream itself proved to be the burial 
place, and on digging disclosed the nearly full term fetus. 

Efficiency in the line of investigation suggested above depends on 
long experience in micro-analytic work and on a wide range of micro- 
scopic study of all kinds of substances, animal, vegetable and min- 
eral. The time required to qualify as expert in this line would vary, 
depending on personal differences; but in all probability the requisite 
experience, in addition to the necessary educational preparation, such 
as medical course, university course, special college course, etc., could 
not be attained in less than ten years of constant application. 

In medicolegal cases the nail deposits should be taken in the pres- 
ence of the chief of police, if possible. In some cases it may be de- 
sirable and necessary to take the nail deposits on the spot, and the 
analyst must therefore be vested with the necessary police authority 
to call to his assistance any police officer that may be available. The 
deposits should be examined immediately, if possible, in a laboratory 
supplied with the necessary apparatus and chemical reagents. There 
must be on hand suitable report blanks on which the findings are to 
be recorded in ink or by means of an indelible pencil. 

After the examination is completed, the findings should be sum- 
marized and interpreted. The greatest care must be observed in the 
interpretation of the results of the examination. The analyst must 
qualify as an expert and he must be free from all bias, and in no case 
must he allow prejudice to influence him in any manner whatsoever. 
When called on to give an opinion, he must be able to speak as one 
who knows, and he must cast aside all prejudice both as to the 
scientific and moral principles which may be involved and as to the 
persons or personalities implicated. At no time must he allow him- 
self to be in any way influenced by the opinions expressed by any 
member or members of the police force with whom he is of necessity 
associated. 

Thus far the medical profession has given little attention to the 
part played by the finger nail deposits in the transmission of infec- 
tions. That there is danger in the handshake is generally recognized 
and admitted by the laity as well as the medical fraternity, but so 
far there is no effort made to do away with this ancient custom. 
There are certain persons who refuse to shake hands or who do so 
under mental protest. The Chinese do not shake hands with each 
other, but perform this ceremony by shaking hands with themselves. 
The chief source of danger in the handshake is in the dejnjsits undrr 
the finger nails rather than in the hand and finders. 1 he more im- 
portant infections traceable to the finger nail deposits may be divided 
into two groups as follows: 

1. Autoinfections. — There is no doubt that many skin diseases are 
traceable to scratching. Of such nail borne autoinfections we may 
mention lupus, acne, boils and carbuncles, and septicemia. In this 



372 ORAL HEALTH 

manner infections are carried to nose, to eyes, to ears and to mouth 
and throat. Skin infections are transferred from one part of the body 
to another by the scratching and skin picking habit or by constantly 
"digging" or "picking" at a sore spot, and as a result some persons 
are never quite free from boils and acneic eruptions, particularly per- 
sons with low opsonic indexes to the causative infections. Infants and 
young children are constantly picking up infections with their finger 
nails and transferring these to the mouth, nose, throat and eyes. Nail 
biters very frequently infect themselves through the materials under 
the nails. Children and some women have the habit of bringing the 
fingers to the mouth, thus favoring the transfer of infecting material 
from finger nails to mouth. 

2. Heteroinfections. — In many cases the infection is traceable to 
the finger nail deposits of others, as by handshaking, stroking or 
caressing the head or face, etc. There is the case of the husband 
whose neck on the left side was never long free from one or more 
small pimples or boils traceable to his wife's habit of playfully pinch- 
ing his neck. He ascribed the trouble to starched collars, but several 
changes in the laundry brought no relief. During the prolonged 
absence of his wife on a visit with relatives, the trouble disappeared 
entirely to reappear again on her return with a renewal of the playful 
habits. 

It certainly requires no lengthy argumentation to prove that there 
is danger in the finger nail deposits. Most valuable information could 
no doubt be obtained through a careful microscopic and bacteriologic 
investigation of the nail deposits of the different classes and races of 
people. Such information would be of inestimable value to physi- 
cians, to sanitarians and to the public in general. Furthermore, the 
occasional if not routine examination of finger nail deposits of patients 
would frequently give the attending physician valuable information 
regarding the source of the causative infections and personal habits 
which might have bearing on the disease. 

This brief outline of a very important as well as interesting subject 
will, it is hoped, serve as a stimulus to others for making additional 
observations and investigations along the lines indicated. — The Jour- 
nal of the American Medical Association. 



Saving Time in Making Plaster Casts.— A strip of card- 
board bent around the impression, with the two overlapping ends 
pmned together, produces a beautifully finished cast and saves a 
great deal of time otherwise consumed in trimming the cast. The 
cardboard can be cut to any width according to the desired thickness 
of the cast. After the plaster cast has been poured the plaster is 
levelled off to the margins of the cardboard, which is removed when 
the plaster has sufficiently set, producing a very pleasing result in 
regard to smoothness of the cast. — Dental Cosmos. 



Report of the Free Dental Dispensary, 
Poughkeepsie, N.Y. 

Stephen Palmer, D.D.S., Chairman of Dispensary 

Committee. 



AS Chairman of the Free Dental Dispensary Committee of the 
Poughkeepsie Institute of Dentistry, I submit herewith the 
first report of the Dispensary, including the activities since its 
opening one month and a half ago, and also a short resume of the 
history from its inception. 

"There is not one single thing more important to the public, in the 
whole range of hygiene, than the hygiene of the mouth," 

This assertion and many others just as convincing, made by such 
eminent English and American surgeons as Doctors Hunter, Osier, 
Mayo and Vaughan, brought to the attention of educators and 
medical men the truths that the dental practitioner has been advo- 
cating for years — That on the cleanliness of the mouth and teeth 
depends the health of the body. It needed just a word from surgeons 
of renown to kindle the flame which has burned in the minds and 
hearts of educators and dentists, until to-day, many dental dispen- 
saries are being established in cities and towns of foreign countries as 
well as our own. Philanthropists are giving of their wealth to estab- 
lish them, and dentists of their time to endeavor to convince educa- 
tional and city administrative boards of the necessity of free dispen- 
saries in the schools, and also to lecture to the pupils along the line 
of proper care of the mouth — the gateway of the body. 

It was three years ago, after much discussion, that the members 
of the Board of Education and a majority of the ethical dental prac- 
titioners of the city met at dinner, having as their guest. Dr. William 
A. White, then oral hygiene lecturer of the New ^'ork State Board 
of Health, who, with others endeavored to make clear to the mem- 
bers of the board the necessity of, and the advantage gained, by the 
establishment of a dispensary in our schools. At that time Dr. \\ hite 
talked at nearly every school in the city, accompanied by our present 
superintendent of schools, who, although convinced, saw the need of 
a dental dispensary more than ever, and from tiial tinu' until this, it 
has been years of continual activity, until to-day we \u\\c a dispen- 
sary, equipped with the most modern outfit and a salaried operator 
and attendant, on duty four hours each day during the school year, 
relieving the suffering and preserving teeth that otherwise would be 
beyond usefulness on account of decay, which would eventually lead 
to bodily disease, and finally, undeveloped boys and girls and sickly 
men and women. 



374 ORAL HEALTH 

On October 9 of this year the dispensary was opened with a pub- 
lic reception and meeting in the School Administration Building, on 
Washington Street, when addresses were made by Dr. Harold D. 
Cross, of the Forsyth Infirmary of Boston, Massachusetts, Professor 
Sylvester R. Shear, Superintendent of Schools, and others. 

The dispensary was made possible by the co-operating of the 
Board of Education and the eleven dentists of the city, composing 
the membership of the City Dental Society. It is under the control 
of both bodies, from which committees are appointed to supervise its 
management, and it is carried on for the immediate benefit of the 
needy boys and girls, and we believe it will be the means of advanc- 
ing their education, as it is a world-wide opinion that teeth, both 
temporary and permanent, are the most essential factors in the pro- 
motion of health and intelligence of the child, and upon their care 
and condition depend their strength and educational ability, as a 
large percentage of retardation in the schools is traced to imperfect 
and neglected dentition. 

In the equipment of the dispensary there is a set of cards which 
are used for reference and investigation, as there is an age limit of 
the eligibility of the applicant, and a limit to the income of families, 
from which they may be received and treated, as in this way only the 
needy can be cared for, and those unworthy eliminated. Also a set 
for keeping an accurate record of all operations performed, and for 
the sake of the future of the child, notices are sent them at stated 
times that they may visit the dispensary for prophylactic treatment 
and examination, thus preventing a recurrence of the deplorable con- 
dition found in many mouths. Prevention rather than cure, is the 
motto of modern dentistry and medicine. 

The future work of the dispensary is not to be relief and restora- 
tion only, but rather educational, as the attending operator and 
assistant are expected to so instruct every applicant, that when they 
are dismissed they will know the value of a clean and well kept 
mouth and teeth, and how to keep them so. There is also a little 
booklet, "The Poughkeepsie Dental Dispensary," compiled by the 
writer, which is handed to each applicant as he leaves the room, 
setting forth many important truths for the child and parent. 

Since the opening of the dispensary to the closing of the schools 
for the holiday recess it has been in operation two hundred and one 
hours, with the following result: 

Fifty-one applicants, from all grades in the schools below the High 
School. 

Seventy-one extractions consisting only of temporary teeth, ex- 
cepting eight, which owing to the average age (nine years) of the 
applicants (the period when the greatest number of permanent six- 
year molars, are found in a badly carious and broken down condi- 



ORAL HEALTH 373 

tion) shows that many of these important teeth are restored to use- 
fulness. 

One hundred and sixty-three treatments, including treatments for 
relieving pain, devitalization of pulps, and treatment of abscesses. 

Three hundred and thirty-five fillings, which mcludes removal of 
nerves and filling of root canals, and the insertion of cement and 
amalgam fillings. 

Twenty-seven prophylactic treatments (every patient is given this 
treatment before being dismissed). 

Three radiographs have been taken for cases needing such, to 
determine the condition of the roots of the teeth, and jaws. 

Many cases have been referred by the dispensary operator to 
practitioners of the city who are always willing to assist in every way, 
to advance the cause, believing that from the result of the work done 
in the dispensary many of the boys and girls will be inspired to keep 
en with their studies. Many will be able to be more regular in 
attendance at their classes, as without good teeth and clean mouth a 
child cannot masticate its food properly. Without proper mastica- 
tion there cannot be proper digestion, without proper digestion there 
will be poor and unhealthful assimilation, and as upon proper assimi- 
lation depends the strength and health of our boys and girls and the 
future men and women, we believe we are building for a stronger 
and healthier coming generation. 

It is the ambition of the promoters of this enterprise to carry on 
the propaganda of oral hygiene and prophylaxis until every city and 
town shall have a school dental examiner, a free dental dispensary, 
and operator and nurse in attendance in every school building, and 
every pupil in the public schools of the land will be given a text-book 
on oral hygiene, and be taught the importance of the care of the 
mouth and teeth. May the day speedily come when our ideals may 
be realized. 

Speaking for the Dental Society, as chairman of the Dispensary 
Committee, every member is enthusiastic, and willing to assist in 
promoting the cause, which we believe to be one of the greatest, if 
not the greatest, agents for the improvement of the health of our city, 
and as a society we appreciate most heartily the interest and support 
given us by Superintendent Shear. President Rust and the Board of 
Education as a whole, in the establishment and conducting of the 
dispensary which places Poughkeepsie in the class with larger cities 
of our state and nation. 

*'The care of the teeth in the public schools is the foundation of 
the health of the nation," so says the president of the International 
Hygiene Congress, and let to that bo added: There is no single 
factor that so impoverishes a community as disease, and there is no 
single factor that so greatly predisposes disease as bad teeth and bad 
oral hygiene. 



Septic Teeth. 

By John Sayre Marshall, M.D., Sc.D., F.A.C.S., Captain, 

U. S. Army, Retired. 



THE subject of this paper is one that is being much discussed at 
the present time. The seriousness and importance of the sub- 
ject will, we are sure, be admitted by all who have given it 
thoughtful attention. 

Suppurative and septic conditions of the mouth are exceedingly 
common and are, in a large majority of cases, associated with the 
teeth. The statement has been frequently made, and the fact is gen- 
erally recognized, that dental disorders are the most common of all 
diseases that afflict the human race, and that many diseases of obscure 
origin affecting the general system, — such as chronic dyspepsia, gas- 
tritis, gastro-enteritis, chole-cystitis, nephritis, diabetes, and certain 
nervous affections, tonsilar diseases, pharyngitis, bronchial and pul- 
monary affections, certain diseases of the eye and ear, and general 
septic conditions, such as septicemia and pyemia, etc., may often be 
traced to an infection from a septic oral cavity. 

A septic oral cavity is generally, if not always, the result of 
neglectful habits due, usually, to ignorance of the dangers to health 
and life that surround such conditions. Neglected dental plates, 
bridges and crowns, faulty fillings, deposits of decomposing food 
debris, salivary calculus, dental caries, gangrenous dental pulps, acute 
and chronic dento-alveolar abscesses, pyorrhea alveolaris, gingivitis 
and stomatitis in their various forms are all active factors in pro- 
ducing a septic mouth. 

Dental surgeons have been trying for years to impress this fact 
upon their patients, and upon the medical profession generally, but 
their efforts have usually fallen upon indifferent or deaf ears. With a 
few notable exceptions they have, until quite recently, made but few 
converts among medical men. These gentlemen, as a rule, have 
looked askance at any opinion upon a medical or surgical subject 
coming from a dental surgeon; saying in some instances that it would 
be better "the shoemaker should stick to his last!'* This attitude has 
doubtless retarded an earlier and more just conception of oral sepsis 
as an ever-present menace to individual health. 

The subject of oral sepsis is one of vast importance from the 
public health standpoint also; it is not second to any other that con- 
cerns the physical and mental welfare of the people; for it strikes at 
the very foundations of the race in that 75 to 95 per cent, of all public 
school children are suffering from it,* and as yet no adequate meas- 
ures have been put in operation to cure the evil or arrest its progress. 

*See (1) Bitoliography. 



ORAL HEALTH 377 

It is very evident that the profession, and the public generally 
are not fully awake to the seriousness of the problem, nor to their 
individual and collective responsibility in the matter, for, if they were, 
the conditions would soon be corrected. 

The introduction of vaccination against smallpox has almost 
driven this disease from the face of the civilized portions of the earth. 
Great efforts are being made to stamp out the scourge of tuberculosis. 
Much has been done to prevent cholera, diphtheria, tetanus, rabies, 
yellow fever, typhoid fever, cerebro-spinal meningitis, etc., but prac- 
tically very little has been done to rescue the 95'^ of school children 
from the dangers of oral sepsis. 

That the dangers to health from oral sepsis are very great no one 
will deny; but there is at the present time a tendency upon the part 
of many medical men to over-estimate this danger, and to ascribe to 
oral sepsis a greater pathologic importance than it deserves. Not 
that septic teeth are not a grave menace to the general health, but 
that we are liable to overlook the fact that the oral cavity is not the 
only) location of septic foci. 

There are many other diseased areas which may furnish foci of 
infection equally grave; for instance, chronic appendicitis, abscess of 
the kidney, of the liver, infections of the gall-bladder, the pancreas, 
the Fallopian tubes, the maxillary sinus, the frontal sinus, the acces- 
sory sinuses, etc., etc. These conditions, however, are much more 
rare than are septic foci of the oral cavity; but the possibility of their 
presence should not be overlooked. That they are frequently over- 
looked and the teeth made to act the part of the scape-goat, there is 
no denying. 

This is shown by the fact that many medical men are insisting that 
their patients shall have all teeth extracted that show any signs of 
suppuration, regardless of the probability that many of these teeth can 
be saved by appropriate dental treatment. Are not some of us allow- 
ing ourselves to be carried by the popular wave too far afield, and 
away from the safe, common-sense, well-beaten track of a wise con- 
servatism ? 

That the difficulties in locating the particular focus of infection 
in any given case of systemic disease are many, there is no gainsaying. 
This calls for special knowledge in many subjects, and few men arc 
so gifted in all departments of medical science as to be M^ to dis- 
pense with the services and knowledge of the trained specialist 

Dr. Frank Billings,^ of Chicago, in si>eaking of the difVicullies of 
locating the various foci of infection, and establishing the character 
of the micro-organisms present, says. "This requires team-work of 
the clinical and laboratory workers. The clinician must carefully 
examine the patient, exhausting every detail of the personal history. 
The skill of the dentist, the nose and throat specialist, the gynecologist. 



•See (2) Bibliography. 



378 ORAL HEALTH 

the genito-urinary expert, and others, may be necessary to locate the 
foci of infection. The foci must be destroyed. Tissues and exudates 
of foci should be carefully examined, and bacterial cultures made." 

Professor Osier, t in a recent address to the students of the Royal 
Dental Hospital of London, said, "You have just one gospel to 
preach, and you have got to preach it early, and you have got to 
preach it late, in season and out of season. It is the gospel of the 
cleanliness of the mouth; cleanliness of the teeth; cleanliness of the 
throat. These three things must be your text through life." 

"Oral hygiene — the hygiene of the mouth — there is not one single 
thing more important to the public in the w^hole range of hygiene than 
that; and it is with that which ycu, as practitioners, will have to 
deal." 

Professor Osier has also placed himself on record in relation to 
the serious effects of dental and oral disease upon the general health 
by saying, "If I were called upon to state which, in my opinion, 
caused the most evil — alcohol or decayed teeth — I should unhesitat- 
ingly say decayed teeth." 

To Dr. William Hunter$ of the London Fever Hospital belongs 
the credit of being first to arouse the medical profession to a realizing 
sense of the great dangers to individual and public health from oral 
eepsis, by the publication in the London Practitioner of his researches 
and personal experiences upon this subject. Let me quote just a few 
of the pregnant sentences in his introduction: 

"For the last twelve years, in connection with various studies, my 
attention has been called in increasing degree to an important pre- 
valent source of disease; one whose importance, I think, is not suf- 
ficiently recognized. The source is oral sepsis — sepsis arising in con- 
nection with diseased conditions of the mouth. My attention," he 
says, "was first drawn to it in connection with the pathology of 
anemia; and since then it has been extended in connection with the 
pathology of a great number of infective diseases which have one 
factor in common, viz. — septic organisms underlying them." 

In a later communication,* he shocked the dental world by his 
criticism of many of the dental operations now performed, because 
of their unsanitary and unhygienic methods of procedure or construc- 
tion; and the retention in the mouth of many diseased teeth and sup- 
purating roots, which it would have been better to have extracted and 
so have eliminated the source of infection. 

The difficulty with Dr. Hunter's criticism was that he arraigned 
the whole profession, for he made no distinction between the honest, 
scientific dentistry performed by the better class of practitioners, and 
the dishonest, unscientific, slovenly dentistry practiced by the quacks. 

tSee (3) Biibliography. 
JSee (4) Bibliograpihy. 
*S'ee (5) Biibliography. 



ORAL HEALTH 379 

What he said about the latter was eminently true and just; but 
when applied to the honorable, conscientious dentist was eminently 
untrue and unjust, as every fair-minded medical practitioner must 
admit. It was this criticism which has been taken up by many medi- 
cal men without proper investigation, that has brought about this de- 
sire for the wholesale extraction of all diseased teeth, regardless of the 
possibility or the probability of their being rendered healthy and in- 
definitely useful by proper dental treatment. 

In no portion of the human body can there be found in so small 
a space so many individual organs that are each capable of becoming 
the seat or focus of a septic infection as in the oral cavity. I his 
cavity usually contains thirty-two teeth, each one of which may, 
under favoring conditions of disease, at some t-me or ether, become 
the focus of a septic infection. 

But this possible number of septic foci may be greatly increased 
by reason of the fact that many of the teeth have multiple roots, and 
each root may become a separate focus. The superior molars have 
each three roots, and the inferior molars two, while the superior fir^t 
bicuspids often have dual roots. Hence, figuring upon this basis, 
there would be fifty-four individual locations where septic foci might, 
under favoring pathologic conditions, be established. This does not 
take into account the large area of mucous surface which covers the 
lips, cheeks and gums, nor the very extensive area of pericementum 
which may become the seat of septic inflammation in g"ngiv'lis, stoma- 
titis and pyorrhea alveolaris. 

Dr. Charles H. Mayo*f in a recent address before the Section on 
Stomatology of the American Medical Association called attention 
to the fact that "A comparatively small number of infections occur 
through wounds of the cutaneous surface. ^f- ^ ^ Infections 
which produce the greatest number of diseases enter the system by 
way of the alimentary and respiratory tracts. Somewhere in the li[i\ 
then, of the alimentary and resj^iratory tracts and in the excretor\ 
ducts of the body lie the sources of the entrance of organisms wh'ch 
terminate life in the majority of instances. 

The great importance of the well-known diseases of the nasal 
passages with their sinuses, the lymphoid tissue of the pharynx, in- 
cluding the tonsils, and the diseases of the gums and the teeth, wh'ch 
have been given {prominence by the dental profession dur^nj:; the la^t 
three years, is now more generally apj^reciated. 

Rcsenow says,^' **While the most common location of the focus 
in various infections is probably in the head, it may be located else- 
where. Thus, in two cases of typical rheumatism, we succeeded in 
isolating the Stref^tccocciis rhcunmticus from the stool; in one from 
an infected ingrowing toe-nail, and in another case from the wound 
in the thumb following a crushing injury.'* 

tSee (0) Ri'blidmnphy. 
*Seo (7) r>ibli(i,L;i-aj>liy. 



380 ORAL HEALTH 

Billings and Rosenow have repeatedely emphasized the fact that 
the oral cavity is the most prolific source of focal infection, and yet 
they place the tonsils at the head of the list. In this, I believe, they 
have over-estimated the tonsils as a source of focal infections, for 
there is no doubt in my own mind that the tonsils usually receive 
their primary septic infections from the mouth and the teeth. 

No one knows better than the dentist, the oral surgeon and the 
nose and throat specialist that, with the ordinary individual, the mouth 
is the most filthy cavity of the human body, reeking with decomposing 
food debris, and millions upon millions of bacteria of saprophytic and 
pathogenic character. 

Is it any wonder, then, that the tonsils should so frequently be 
the seat of septic inflammations? 

Tonsilitis is rarely seen in connection with a clean, rvell-I(ept 
hygienic mouth. 

Septic Teeth. 

By septic teeth, we mean all teeth in which by disease or 
traumatism pulp vitality has been lost. These teeth are in a septic 
condition by reason of the putrefaction of the devitalized pulp 
remaining in the pulp-chamber and root canals. Or, by the de- 
composition of the organic material of the dentine — namely, the dental 
tubuli and fibrillae, in teeth which have not been properly sterilized 
and the root-canals hermetically sealed. 

Every devitalized tooth which has not been properly sterilized 
and the root-canal hermetically sealed from its apical foramen to and 
including the break in the continuity of the dentin and enamel, 
whether it be from a cavity of decay, or a surgical traumatism made 
to gain access to the pulp chamber and canal, is liable sooner or later 
to become the seat of a septic infection. 

This statement cannot be successfully controverted. 

Teeth which are affected with pyorrhea alveolaris are also septic, 
from suppuration in the alveoli, and are a source of grave danger 
to the general health; but their consideration at this time would un- 
duly prolong the limits of the paper, and must therefore be excluded. 

We shall confine our discussion at this time to devitalized teeth — 
to be more explicit — to those teeth which have lost their pulp vitality, 
and are in a septic condition. 

Some years ago it was my pleasure to make an extended series of 
examinations of extracted, devitalized teeth, the roots of which had 
been filled, and the apical foramen sealed — perfectly — so far as the 
unaided eye could detect. These teeth, upon being split open in a 
longitudinal direction, gave in nearly every instance unmistakable 
evidence of being in a septic condition, by the intolerable odor of 
decomposing organic matter. The only cases in which this odor was 
not present were in those devitalized teeth the root-canals of which 
had been filled with iodoform cotton. These teeth, however, in nearly 



ORAL HEALTH 381 

every instance showed signs of inflammatory processes at the apices 
of their roots. The odor of decomposition had, however, been covered 
up by the greater mal-odor of the iodoform. 

It is estimated that the dentine contains about 28' ' of organic 
matter which — after the devitalization of the pulp — rapidly takes on 
putrefactive changes, with the generation of mephitic gases and bac- 
terial poisons, unless the tissues have been thoroughly sterilized. 
The teeth have two sources of blood-supply and enervation, namely, 
through the pulp, and through the pericementum. The pulp is the 
vascular and enervating organ, and gives to the dentine its nutrition 
and sensation, while the pericementum performs the same office for 
the cementum and the structures of the dento-alveolar joint. 

The loss of pulp vitality does not necessarily mean the complete 
death or necrosis of the tooth, for so long as the pericementum con- 
tinues to perform its functions, a pulpless tooth may remain in the 
jaw for an indefinite period. It is, however, more liable to be attack- 
ed by dental caries than with teeth, and infinitely more susceptible to 
traumatic injuries and septic infections, by reason of its loss of vital 
resistance in the tissues supplied by the pulp with nutrition. 

These facts, though well known to the profession, have often been 
overlooked, or entirely ignored, by many reputable dental practition- 
ers, and pulps needlessly and ruthlessly destroyed for the purpose of 
inserting crowns and bridges, where fillings and plates would have 
been a better and more conservative practice. Worse than this, how- 
ever, has been the practice of many so-called dentists quacks who. 
for a few paltry dollars, have been willing to jeopardize the health 
and life of their clients by placing crowns and bridges upon the roots 
of teeth so diseased that they were entirely beyond the pale of suc- 
cessful treatment; no effort being made to sterilize the canals, or fill 
them, except by a carbolic acid dressing covered with oxy-phosj>hate 
cement or gutta-percha. 

The successful treatment of iHili:)less teeth calls for a high degree 
of technical knowledge in the fields of dental anatomy, histology, 
pathology, bacteriology and therapeutics; while the surgical and ma- 
nipulative skill required to successfully fill the root-canals of such 
teeth must be of the very highest order. There is no operation, to 
my knowledge, performed by the general surgeon, or any specialist 
connected therewith, that can compare witii this in the analomic.il 
difficulties to be overcome; the minuteness of the area to be operated 
upon; the delicacy of the instruments employed; or the skill required 
for its performance. 

Medical men are sometimes inclined to harshly criticise the dental 
surgeon for his failures in treating pulpless teeth. 1 he failures are 
many, we admit, but he should be commended for the measure of 
success he achieves against such odds, and his failures, when they 
occur, condoned. 



382 ORAL HEALTH 

As soon as a pulp is exposed by caries, or loses its vitality by 
traumatism, the pyogenic organisms attack it in the first instance, and 
the saprophytic germs in the second; and putrefaction and liquefaction 
of the necrosed tissue takes place. At this time, the predominant 
micro-organism present is the bacillus gangrenae pulpae of Arkory, 
an exceedingly virulent organism, as you would soon learn if you 
should be so unfortunate as to wound a finger with an instrument 
that had been in recent contact with such a pulp. 

Another organism which is frequently found in the canals of pulp- 
less teeth and in apical abscesses is the streptococcus viridans. This 
organism is usually the dominant factor in the production of systemic 
diseases, such as malignant endocarditis, chronic arthritis and 
myositis. (Billings).* 

The dominant organisms according to Billings, J found in infected 
alveoli and tooth canals belong to the streptococcus-pneumococcus 
group. 

This investigator further says: "Systemic disease due to a focus 
of infection anywhere is probably always hematogenous." .... 
*'Local hemorrhage and endo-arterial proliferation result in intersti- 
tial overgrowth, cartilaginous, osseous, vegetative and other ana- 
tomical changes, dependent on the character of the tissue involved." 
. . . . He further thinks it susceptible of proof that a "chronic 
alveolar infection, and chronic infect'cns in other regions also, may 
cause systemic disease by hematogenous bacterial emboli, which infect, 
and at the same time deprive the tissues of nourishment. Local in- 
fection of muscles, joint tissues, etc., and lessened blcod supply result 
in the peculiar morbid anatomy of the respective tissues." Endocar- 
ditis, arthritis deformans, cementosis and pyorrhea alveolaris are all 
examples. 

Rosenow says: t"The abscesses or bony changes found about the 
roots of teeth in various systemic diseases, especially in cases of 
chronic arthritis, may or may not be primary, but, if found, the con- 
dition should be corrected, because vaccine or other treatment largely 
fails as long as there exists an active focus of infection, as shown 
particularly by Billings. 

My study on the effects of varying degrees of oxygen tension on 
the members of the streptococcus group, together with other facts, 
makes it likely that it is in the focus of infection that changes in 
virulence occur, and the different affinities for various structures are 
acquired. In ether words, the focus of infection is to be looked for — 
not only at the place of entrance of the bacteria — but also the place 
where the organisms acquire the peculiar property necessary to infect. 

In the light of our present knowledge, the argument that infec- 
tions in the mouth are so common in individuals in apparent health 

*See (8) Bibliography. 
$See (9) Biibliograipihy. 
tSee (10) Biibliography. 



ORAL HEALTH 383 

does not minimize their importance. These, or ether foci, are so 
common in patients suffering from arthritis, appendicitis, ulcer of the 
stomach, and cholecystitis, goitre, etc., and so rare in individuals who 
have had superb health for years, that their direct etiologic role can 
scarcely be questioned." 

All devitalized teeth that have not been properly treated by the 
extirpation of the pulp, sterilization of the dentinal tubuli, and their 
contents, and hermetical sealing of the canad and apical foramen arc 
septic. 

This statement needs no verification, for it should be patent upon 
its face to every one. When a root-canal has been treated aseptically. 
and sealed as just indicated, it is as nearly safe and innoxious as it 
IS possible for present human skill to make it. And yet it is not 
entirely secure against inflammatory processes by reacon of its lowered 
vital resistance, nor against the dangers from hematogenous bacterial 
emboli, and consequent lessened blood-supply, to its pericementum. 

The establishment of a diagnosis should in all cases be made 
through consultation with a competent dental or oral specialist. The 
diagnosis of sepsis having been definitely established, one or the other 
of two operations should be immediately performed, namely: the 
securing of complete and perfect surgical drainage: or the extractioii 
of the offending tooth. It is worse than folly to attempt drainage 
through the roct-canal, as is often done by the dental surgeon. ^ ou 
might as well try to drain a lake through an inch pipe as to drain a 
dento-alveolar abscess through so small an opening as the apical fora- 
men of a tooth. 

Perfect and complete surgical drainage cannot be secured except 
at the most dependent portion of the abscess, and through an opening 
large enough to immediately evacuate its contents and prevent 
clogging. Pus will no more flow up-hill than will water, and yet, 
many dentists expect it to accomj:)lish this imj^ossible feat, as is evi- 
denced many times by their methods of operating. 

A dento-alveolar abscess cannot be properly drained except by 
puncturing the external alveolar plate, and this is what Nature does 
when she forms a fistula. The i:)roiicr place to |iuncture the alveolar 
plate is immediately opposite the apex of the root that is involved. 
This may be done in a moment with a spear-pointed drill, under local 
anesthesia. Such drainage is efficient and gives immediate relief. 

Extraction cf these septic teeth should bo the last resort, for the 
teeth are valuable organs and should not be ruthlessly sacrificed; yet 
the health and life of the individual are worth more than rnanv teeth. 
When the value of a tooth is weighed against tho health of the indi- 
vidual, there is no question about which shall be sacrificed. VI e know 
of no circumstances under which the exercise of good iudc;ment and 
a wise conservatism are of greater value to the p.Uuiit th.iii in cases 
of this character. 



384 ORAL HEALTH 

Unless drainage is complete, and can be so maintained, it is better 
to remove the tooth and curette the abscess cavity, removing all dis- 
eased and infected tissue. 

With the foci of infection removed — and there is often more than 
one, as the roentgenogram will show, the case will immediately, in 
most instances, make a rapid recovery. 

Physicians are sometimes, however, greatly disappointed in some 
of their cases, especially in rheumatic arthritis, arthritis deformans, 
and endocarditis, because after every discernible focus of infection has 
been removed, these cases show little or no improvement. This is due, 
in all probability, to the fact that the foci of infection were not re- 
moved until after the damage to the tissues had been done by the 
hematogenous emboli, and the lessened circulation and nutrition of the 

parts. , . r 1 • J 

Billings says: ^"Partial or complete eschemia of the tissues due 
to embolism is an important factor in the production of morbid ana- 
tomical changes." .1 1 
Tissues so changed rarely, if ever, resume their original normal 
condition. Early recognition, therefore, of focal infections associated 
with septic teeth, would often prevent the establishment of many 
serious local and general disorders. 

It is evident also, in view of the foregoing facts, that a closer 
general relationship and co-operation should exist among the gen- 
eral practitioners of medicine and surgery, the dentist, and other 
specialists, as this would redound to the lasting benefit of the patient 
suffering from diseases due to septic foci in various parts of the body. 

Bibliography. 

(1) Marshall — Operative Dentistry^, 4th Edition, pp. 133-135. 
Marshall — Mouth Hygiene and Mouth Sepsis, 1st Edition, 

pp. 24, 25, 26. 

(2) Billings — Journal Am. Med. Assn., Vol. LCIII, p. 2025, 

1914. 

(3) Marshall — Mouth Hygiene and Mouth Sepsis, 1st Ed., p. 

3-4. 

(4) Hunter — London Practitioner (1900), Monograph Oral 
. Sepsis (1901). 

(5) Hunter — London Lancet, Jan. 14, 1911, pp. 79-86. 

(6) C. H. Mayo— Journal Am. Med. Assn., Vol. LXIII, p. 

2025, (1914). 

(7) ROSENOW— Journal Am. Med. Assn., Vol. LXIII, p. 2026, 

1914. 

(8) Billings— /ourna/ Am. Med. Assn., Vol. LXIII, p. 2024, 

1914. 



*See (11) Bibliography. 



ORAL HEALTH 385 

(9) Billings— /ourna/ Am. Med. Assn., Vol. LXIII, p 2023 

1914. 
(10)— RoSENOW—y ourna/ Am. Med. Assn., Vol. LXIII, p. 2027. 

1914. 
(11) Billings — Journal Am. Med. Assn., Vol. LXIII, p. 2024 

1914. 

— Pacific Denial Cazetie. . . 



Periodontia. 



Paul R. Stillman, D.D.S., New York, N. Y. 



TWENTY years ago, dentistry was held in low esteem as a 
vocation. Developed as a separate and independent science, 
by men equipped with meagre preparation in the fundamentals 
of surgery and pathology, it was considered too cramped and narrow 
a field for the ambitious student with broad scientific tastes. To- 
day, as a profession it is broad enough to satisfy students with the 
highest ambitions for scientific research or professional attainment. 

Root-canal Filling Once and Now. 

During the period when dental service was largely confined to 
metallurgy, mechanics, the extraction of decayed teeth and the substi- 
tution for them of artificial plates, when the treatment of root-canals 
was a procedure fraught with doubtful prognosis, and prophylaxis of 
the mouth held as an operation beneath the dignity of the profession, 
dentistry was well within the range of its educational capabilities. 
But with the introduction of gold bridge work came the necessity 
of "saving" certain teeth that they might act as abutments, and the 
temptation to retain in the mouth teeth with gangrenous pulp con- 
tents, teeth having pathological periodontic lesions, or those with 
formerly vital pulps which were necessarily destroyed to permit tlv* 
employment of a dowel or shell crown in bridge construction, created 
a problem requiring a degree of knowledge with which the average 
dentist was not equipped. Thus, ever since the advent of the bridge, 
root-canals containing necrotic pulj) remnants may be found under a 
large percentage of crown abutments. One investigator reports a 
failure of 83 per cent, of all root-canal operations, as revealed by 
radiography, in many hundreds of cases examined; another authority 
states that not 2 per cent, of all root-canal operations are free from 
apical infection. 

In those times the poor peasant and the backwoodsman, having 
neither the means to secure nor access to the service of the dentist, 
and therefore allowing their teeth to crumble with decay and break 
off, were spared the physical disasters following the filling and crown- 



386 ORAL HEALTH 

ing operations performed upon those who enjoyed greater oppor- 
tunities. Instinctively, they knew that when drainage of the necrotic 
pulp was maintained, pain from infections in the periapical region 
was inhibited, as the profession knows that the hermetical sealing of a 
pathologic pulp with a filling or crown is followed by a loss of drain- 
age and an alveolar abscess. 

Most of us are Doctors of Dental Surgery, and it is assumed that 
all surgical procedures have the same fundamental principles and 
precepts; but where, in the annals of surgical history, may be found 
precedent for sealing within the human body septic and necrotic 
tissue? Yet this is exactly the kind of surgery that the vast majority 
of our patients have received at our hands. It is difficult to conceive 
of a more pernicious or unscientific procedure. It is the tragedy of 
dentistry; it is a surgical crime committed by the vast majority of us 
upon our own patients; it is an attack upon the physical welfare of 
society, and the distant rumblings of the approaching storm of indig- 
nation and protest may be distinctly heard. Root-filling requires the 
cleaning-out of the whole pulp contents under the same aseptic con- 
ditions that apply in other surgical procedures. It may not be as- 
suredly accomplished without the aid of the X-ray. The roots are 
to be filled to and through the apical foramen. Credit for the refor- 
mation in teaching may be ungrudgingly given to a few enlightened 
men who understood the pathological principles, and fearlessly com- 
pelled our attention to the havoc resulting from septic root-work. So 
long as dentistry lives, the names of Callahan, Rhein, Ottolengui, Best, 
Grieves, and a few others will also live in this connection. 

Like medicine, dentistry has made some very serious mistakes that 
are now covered by six feet of earth and a marble slab. 

Systemic Diseases of Dental Origin. 

Many of the constitutional diseases of obscure or unknown origin 
that physicians and surgeons have been called upon to treat in the 
past are now traced to a dental source. It was at first recognized 
that the infected tonsil and rheumatic disorders had significant con- 
nection; later the researcher found that the uric acid diathesis theory 
had slight scientific basis in fact. Recent work has identified the 
intimate connection between periodontic infection and such diseases 
of formerly obscure etiology as rheumatism, myocarditis, arthritis de- 
formans, gastro-intestinal toxemia, certain neuralgias, and many 
other lesions. Gingival and alveolar infections of numerous forms 
which have carelessly fallen under the generally accepted term of 
pyorrhea, and periapical infections, are the two great sources of oral 
sepsis. The latter, probably, are the most insidious of all oral foci, 
because the presence of the lesion can only be revealed by the use of 
the X-ray. Radiographs of these suspected teeth that have given no 
pain, that are not sore, that have no sinus discharging into the mouth. 



ORAL HEALTH 387 

will reveal infective processes at the root-end, small cavities where th^i 
bone structure has been lost, showing a rarefied spot upon the film. 
These inter-alveolar cavities usually reveal streptococcus viridans in 
almost pure culture, exactly as has been found on the cardiac tissue 
and the synovial membrane. It has also been shown that strep- 
tococcus has been found in gastric and duodenal ulcers. That there 
is a connection in the coincidences has been confirmed by many re- 
search workers. We, as dental surgeons, must recognize and assume 
our share of the responsibility and labor; the physician or general 
surgeon has neither the training nor the equipment to give relief. 

Periodontia Defined. 
This is the day of the specialist, and while we look almost with awe 
at the wonderful results achieved by men who have given big brains 
and great energies to the pursuance of some single branch of a science, 
we must not lose sight of the interdependence of these branches. 
Periodontia, perhaps the latest arrival among dental specialists, com- 
prises all prophylactic dental procedures, together with the more 
special surgery of all lesions of periodontic tissues. The field includes 
the prevention and treatment of pyorrhea and its allied gingival in- 
fections, as well as much that is included in minor oral surgery proper, 
excepting, of course, exodontia and the marked lesions of the osseous 
structures which require regular hospital facilities with a general 
anesthetic. The treatment of root-canals for the relief of infections of 
the apical area, apicoectomy, and all minor oral surgery, reasonably 
falls under this heading, as does applied dental radiography or. as 
Raper calls it, radiodontia. 

It is not my purpose to assist in the erroneous movement divorcing 
periodontia from geieral dentistry, for I believe that periodontology 
is the keystone of the arch of all other dental branches; neither do I 
wish to include it in the broader field of the healing art of medicine, 
and thus to hope for any other relation to medicine than that in which 
it now stands. The foundations of our structure are laid deeply in 
the necessities of suffering humanity, but the prevention and fMad.ca- 
tion of disease should, after all, have priority of jilace in all dental 
procedure. 

The Need of Prophylaxis. 

In these more scientific days, our sister profession of medicine is 
continually asking the co-operation of dentistry in the work of elmiin- 
ating disease; first, by discarding such methods of our procedure as 
are known to be the cause of systemic infection, and second, by in- 
corporating in our work such measures as will prevent the develop- 
ment or si:)read of disease. Ihat disease does arise from within the 
mouth is no longer a disputable assertion; that dentistry of a certain 
type has been the direct cause of systemic disease is also true. Aside 
from these general infections that demand hygiene within the oral 
cavity, there is a considerable number of diseases which come more 



388 ORAL HEALTH 

particularly within the professional scope of dentistry than of medicine, 
and the opportunity for work in this field is under the hand of every 
dentist. While it is true that 75 per cent, of the cases which come to 
those of us who are making periodontic work our special field of labor 
are or may be classed as pyorrhea, it is also true that the immense 
amount of work in the way of preventing all the diseases to which 
the peridental membrane and its allied structures are susceptible must 
inevitably fall under the scope of the general practitioner. In other 
words, it is the plain, garden variety of dentist — the all-around 
thorough practitioner, and not the specialist — who must undertake 
the work of prevention of disease if any great impression is to be 
made upon the vast problem of oral prophylaxis that awaits prac- 
tical solution. 

If each patient desiring dental service, whether for the relief of im- 
mediate pain or the restoration of some tissue that has been lost 
through disease, should receive at the hands of his dentist proper pro- 
phylactic treatment, who can compute the resultant alleviation of 
suffering to mankind? The initial gingival infection is the forerunner 
of most of the destructive processes that result in the final exfoliation 
of the teeth. 

The whole ahmentary tract, including the human mouth, is a 
veritable incubator for the propagation of germ life. Debris, lying in 
contiguous relation to tooth and gum, finds in the gingival trough a 
place of lodgment. The infection of this debris soon destroys the 
epithelial layer of the mucosa lying next to the tooth, opening a way 
for the passage of bacteria into the vessels, and thence into the blood 
stream. It is here that we may observe a focus of infection. 

Vital Resistance. 

The human body is almost impregnable to invasion of its vascular 
structures just so long as its integument is intact and it has a normal 
power of resistance. It is, under certain conditions, so greatly lower- 
ed in its powers of resistance as to succumb to a violent attack. The 
epithelium lying against the tooth-root on the inverted gingival border 
has cells of smaller size and of lower life potentiality than does the 
outer layer toward the lips and cheek. Every epithehal cell possesses 
a high capacity for regenerative construction, but when we remember 
that the nutrition to this part is supplied by vessels of extreme 
diminution — or, as Talbot characterizes them, end organs; that their 
flow is always interrupted by embolic masses whenever they are in- 
vaded by bacteria, thus shutting off the nutritive element, and that 
the tissue is undergoing desquamation due to the presence of infective 
debris, we realize that its tendency to rebuild seldom can overpower 
the retrograde processes of attack unaided by intelHgent conservative 
prophylactic interference on the part of the dentist. 

It is an accepted theory of pathology that the mucous membrane 
is a natural protection against infection, that the mucous secretion it- 



ORAL HEALTH 389 

self has an inhibitory influence on bacteria, and that, where the con- 
ditions are normal and the resistance high, the chances of infection 
are not great, but with the lowering of vitality — that element in 

combative defence whose function is yet to be fully understood we 

observe a concomitant withdrawal of the element opposed to m- 
vasion. We observe this in case of exposure, followed by a general 
pneumococcus infection, as we also do in grippe, colds, and many 
other conditions which have their foci in the nose or mouth. 

Acute Ulcerous Gingivitis Superinduced by Exposure and 

Hunger. 

I have recently observed an interesting case, from the internist's 
point of view — an acute ulcerous gingivitis, superinduced by ex- 
posure and hunger. A young man in very robust health, a curb 
broker by occupation, whose personal habits in oral hygiene are the 
highest, went on a duck-shooting trip in one of the southern stales. 
The occlusion of his teeth was normal, and his gums, until this attack, 
had always been hard and healthy. Subjecting himself to severe ex- 
posure on a cold, rainy day, his midday ration being lost through an 
accident, he returned to camp at dusk cold, chilled through, and with 
no appetite for food. Concluding that he was too tired to eat, he 
went to bed hungry. The following morning found him with gums 
much swollen, bleeding, and extremely sensitive. I o alleviate this he 
used the only remedy at hand, a solution of salt and vinegar, as a 
wash. He finally decided to return to New York, after four days 
of suffering, and came to me for relief. The case presented a typical 
acute ulcerous gingivitis, with the usual fetid breath and sloughing 
gingival border. It cleared up under treatment, leaving five of the 
interproximal septal papillae entirely destroyed, as well as some of 
the alveolar border. 

This disease is one which is very active in its destructive elements, 
and unless its progress is speedily checked, it inflicts great damage 
upon the periodontal structures. I was perplexed, in reviewing this 
case, to observe a mouth which I had recently seen in such an idiwl 
state of sanitation, so normal in every way, becoming so devastated. 
My preconceived opinion in these cases was that such a mouth was 
immune; that if a mouth was kept healthy through fie(juenl prophy- 
lactic treatments, it was to be considered as safe against such an 
attack. Black, in ''Special Pathology of the Peridential Mem 
brane," does not enter into the etiology of this disease, nor could I 
find in other dental literature any reference to this subject. 

The Permeability of Normal Mucous Membrane by 

Bacteria. 

The reports of Hilgermann's (1) and Flicker's (2) experiments 
on animals regarding the permeability of bacteria into the normal 
mucous membrane seem to throw some light upon the subject. 



390 ORAL HEALTH 

Hilgermann found that when young rabbits and guinea-pigs were 
fed with tubercle bacilH, these organisms did pass through all portions 
of the digestive tract epithelium, but more especially the upper 
part. This passage was not due to lesions of the integument, nor 
was there evidence of penetration in consequence of an irritation pro- 
duced by colonies acting locally. The contrary was observed in 
the normal adult animal except when the vitality was lowered by 
extreme hunger and fatigue. He concluded that the mucous mem- 
brane, under certain conditions, was lacking in the natural protective 
element which normally inhibits penetration. Flicker's experiments 
show that these conditions lend susceptibility to penetration, and that 
the best nourished and strongest organisms are highly sensitive to in- 
fection when subjected to these conditions. He induced hunger and, 
by the use of a treadmill, fatigue in dogs, and observed that its effects 
facilitated infection. He thought it probable that in the time of 
greatly increased muscular exercise, the body cells generally suffer a 
temporary check in their metabolism and in their ability to liberate 
energy. This infirmity in some way influences the epithelium so as to 
favor the passage of bacteria. I am satisfied that these references 
partly explain the infection in the case I have described. 

Bacterial Balance. 

The alimentary tract from the nasal meatus and the lips to its 
distant vent has a continuous unbroken lining of mucous membrane, 
and within its confines it harbors countless millions of micro-organic 
life. Herter (3) estimates the number of both dead and living or- 
ganisms in the daily excreta of the average normal healthy human 
at 126,000,000,000. 

Bassler (4) estimates the average dry-stool specimen of the healthy 
individual to be composed of from one-quarter to one-third in bulk of 
solid bacteria. It is not possible for us to comprehend the infinity of 
these bacterial units. These facts are cited in order to emphasize the 
relationship these figures bear to the bacteriology of this subject. 
While food and drink, as carriers, doubtless account for part of the 
bulk, it is certainly true that there are constantly incubating in a 
pathological mouth organisms which are not benign in their action 
upon the system. To what extent this oral flora contributes to the 
whole we are not prepared to say; but it may be safely assumed that 
a certain proportion has been incubated in the mouth. 

The laws which govern bacterial life are almost identical with 
those which govern biological life, one variety depending upon an- 
other for food and subsistence. No one variety is dangerous until it 
has increased numerically and the bacterial life is thrown out of 
balance, causing a war within the confines of our body. 

The Dentist's Duties of Prevention. 
When we realize that organisms of low pathogenicity commonly 
found in the mouth may readily and rapidly develop a high degree of 



ORAL HEALTH 391 

pathogenic virility through an alteration of environment, we must 
recognize our responsibility in the matter of oral prophylaxis and the 
treatment of periodontic disease. Directly in the line of vision of the 
dental eye appear, first, the indications of disturbances in body 
metabolism. We observe a reddening of the border of the gums 
w^ith the always accompanying hypostasis of the vessels; next we note 
copious deposits of salivary calculus, or the blue spot in the septal 
tissue denoting deposits of another type; again, a pus sinus for a 
chronic apical abscess. Pyorrhea we see from its initial attack upon 
the border of the gum to the deformity of the advanced lesion. 

Let no dentist despise the work that lies here at hand, nor under- 
estimate the import of these significant symptoms, for these are indices 
of incipient disease, and here are spread before our eyes signs which 
reveal disturbance in the metabolic process, so evident as to be un- 
mistakable, offering premonitory evidence of maladies to follow at a 
time when symptoms are recognizable nowhere else in the body. 

I have tried to show that periodontic tissue presents exceptional 
opportunity for the point of entrance of these organisms into the blood 
stream. 

The Surgical Aspect of Prophylaxis. 

The surgical prophylaxis of these initial infections has a simple 
technique when the proper instruments are used, and it requires such 
a few extra minutes of our time to properly instruct a patient in the 
correct manner of making his mouth toilet, that it is inconceivable how 
any dentist can fail to make this the first among his many duties. 

It is a well-known principle in surgery that lesions of infectious 
origin heal when the infective focus is removed, however remote that 
focus may be. We all, as surgeons of the teeth, know that general 
surgery, in the broader sense, no longer uses escharotics to stimulate 
constructive processes in the tissue; that it is impossible to do more 
than mask certain symptoms by the use of drugs; that the employ- 
ment of ipecac will not remove septic or necrotic tissue in the bottom 
of a pyorrhea pocket nor restore these tissues to health. 

How incredibly blind our profession has been toward the accept- 
ance of truth in the matter of surgery as a cure for periodontic dis- 
ease — lending ear to false prophets, giving credence to every new 
nostrum, accepting new superstitioiio because someone has tried them 
and found evidence that they are beneficial and must honce be ex- 
ploited as cures! 

Drugging vs. Surgikv. 

The written works of these men who have exploited instead of 
studying, who have spouted instead of absorbing, have done infinite 
harm to dental thought, and are a power that is being felt now in the 
gravest manner. Hitherto the demand for reform in this sort of leach- 
ing has not been of great force; on the other hand, there is a large 
number of men of clinical rather than l-terary ta-tr^<^ who have de- 



392 ORAL HEALTH 

voted years to the practice and application of surgical principles in 
this work, with satisfaction to themselves and their patients, who have 
found little time in their busy lives to devote to research in pathology 
or histology, and who I^norv their etiology from long clinical ex- 
perience. It is men of this type who have made cures and confirmed 
the findings of their colleagues as to the complete obliteration of the 
pyorrhea pocket and a true reattachment of the periodontic tissue to 
the tooth-root in a state of health — a result never yet obtained by 
other means than by true surgical technique. The work and results 
obtained by these men have been overlooked by our eminent writers 
in compiling the findings of their studies, which explains their 
pessimistic conclusions. These findings, as published, are no less 
valuable on this account, but they are judgments based upon a one- 
sided hearing of the facts. The result is engraved upon the dental 
mind, and students, wavering in opinions from many sources and dif- 
fering widely in conclusions, have packed away their surgical 
pyorrhea instruments on a high shelf, and have resorted to the 
medical applicator or the hypodermic syringe. Later in life, one so 
taught finds his mind registering one-sided ideas and a pessimism to- 
ward any except palliative measures. He may take to the journal 
and the forum and add to the general confusion. He will talk about 
the beautiful results of the ipecac or mercurial treatment, tell how the 
pus stopped, and, what is worse, he will be listened to, read, and be- 
lieved by those men whose information is the same as his own, and 
who are looking for some method where skill and training in this 
special work is unnecessary. 

Bibliography. 

(1) HiLGERMANN. "Die Bakteriendurchlassigkeit der normalen 
Magendarmschleimhaut im SaugHngsalter." Archiv f. Hyg., liv. p. 
335, 1905. 

(2) Flicker. "Ueber den Einfluss des Hungers auf die 
Bakteriendurchlassigkeit des Intestinaltraktus." Archiv f. H^g., 1905, 
p. 354. 

(3) Herter. "Bacterial Infections of the Digestive Tract,*' 
1907, p. 1. 

(4) Bassler. "Diseases of the Stomach." _Oenial Cosmos. 



In Appreciation of the Late Howard James MacLaurin, 

D.D.S., Winnipeg. 

ON that rapidly growing roll of honor containing the names of 
those Canadians who have given their lives for Empire must 
now be placed the name of Dr. Howard James MacLaurin, 
of Winnipeg, who fell bravely leading his men in a charge to regain 
trenches on June 14, 1916. 



ORAL HEALTH 393 

Dr. MacLaurin was born in Vankleek Hill, Ont., July 23. 1887. 
and graduated with honors in 1909 from the Royaf College of 
Dental Surgeons, Toronto. In 1910 he opened a dental office at 
4 Osborne-River Block, Fort Rouge, Winnipeg, where during the 
succeeding five years he built up a large and lucrative practice. 

Soon after the outbreak of war, being deeply impressed by the 
importance of the issues at stake, he offered himself for active service, 
obtaining a commission as lieutenant in the 43rd Overseas Battalion 
ihen being raised by the 79th Cameron Highlanders. With charac- 
teristic energy and thoroughness he threw himself into his new duties, 
and soon passed the examinations for captain's rank. With his 
battalion he left Winnipeg on May 29, 1913, and after two months' 
further training in England was sent to France with a draft to rein- 
force the 16th Battalion, Canadian Scottish. On this occasion he 
first came under fire, and successfully initiated his men into some of 
the duties of trench warfare. Returning under orders to England, 
he was sent soon after to Aldershot for a course in physical training 
and bayonet fighting, but in about two weeks was recalled to pro- 
ceed to France to join the 16th Battalion, being thus the first officer 
of his battalion to see regular service at the front. 

During the nine months following Lieutenant MacLaurin was, on 
five or six occasions, mentioned in reports for daring exploits, chiefly 
reconnaissance work in "No Man's Land." While visiting a listen- 
ing-post in March last he received a gunshot wound in the right fore- 
arm and was in the Duchess of Westminster's Hospital at Letouqucl 
for two weeks. Just about ten days previous to his death he was 
again wounded slightly by shrapnel in the back, but did not go off 
duty as there was a shortage of officers, and he would not leave his 
men in the lurch. 

On June 14 the Canadian Scottish took a prominent part in regain- 
ing several trenches lost to the Germans a few days before. In the 
attack Lieutenant MacLaurin was in command of his comj^any. In 
passing through a curtain of fire he was struck by shrapnel, and while 
being carried off the field was struck again with fatal effect. 

Many will be interested to learn that Lieut-Col. Leckie. in a 
letter of sympathy, states that Lieutenant MacLaurin was twice 
recommended for the Military Cross. 

All who knew the late Dr. MacLaurin testify to his many sterling 
qualities. He was a man of generous impulses and strict integrity, 
and the record he leaves as a soldier shows him to have been pos- 
sessed of great physical bravery and resourcefulness. In his dralh 
the dental profession loses an honorable member and Canada a noble 

son. 

Ma.nly BowLFi^. 

Winnipeg, August 15, 1916. 



The Research Fund of The National Dental 

Association. 



C N. Johnson, M.A., L.D.S., D.D.S. 

AS the time approaches for the meeting of the National Dental 
Association it is well to have particularly in mind the signifi- 
cance of the present status of the Research Fund. During 
the past year, under the direction of Dr. Weston A. Price, the chair- 
man of the Research Committee, wonderful progress has been made. 
A building has been dedicated to purposes of research in the city of 
Cleveland, and substantial additions have been made to the build- 
ing fund and the research fund. 

In a recent ld;ter from Dr. Price he makes the following interesting 
statement: "There has been provided in pledges or cash $27,350 
of the $50,000 required, a little over fifty-four per cent., for the 
building, and the total of all five-year pledges and donations is a 
little over $69,000, which would give us an income, if all could be 
realized without expense for collection, of $13,800. The further 
perfection of the organization and the securing of headquarters and 
an equity in real property has very greatly stimulated the interest and 
confidence in the work, for there has been about three times as great 
an increase in the equities of the Research Department in seven 
months, since purchasing the building, as in the fifteen months pre- 
ceding that time. Unfortunately, it is costing about ten per cent, to 
make collections, besides which many men are careless and are very 
far behind in their payments. It is exceedingly important that our 
income be more ample and dependable and, if possible, the burden 
of providing it more equitably distributed. Six states have already 
voted to adopt the new basis, to increase the dues one dollar for the 
support of the research work, in addition to the increase for the Jour- 
nal. We are confident the entire membership of the National will 
adopt this plan, which will give approximately $18,000 a year for 
research work, w^hich is the interest at five per cent, on an endow- 
ment of $360,000. The trustees of the institute are undertaking to 
raise a million dollar endowment, and they are confident, with the 
support of the profession, that this will be accomplished." 

The chief thing of significance is the spirit which is spreading in 
the profession, chiefly through the noble self-sacrifice of Dr. Price. 
This spirit manifests itself in an awakening wherever he goes to the 
vast possibilities of research work carried on under the initiation and 
support of the profession. There is developing a pride among the 
members in the fact that a profession as comparatively young as 
dentistry and containing so few in numbers can organize and finance 
research work on the scale that this has already assumed. Then 



ORAL HEALTH 395 

there is the earnestness and devotion of those who are actively en- 
gaged in the research work itself under the direction of Dr. Price, 
and the results that are being brought about. One of the chief 
difficulties in this movement is to develop men who are qualified by 
nature, inclination and opportunity to do real scientific work, and 
next to Dr. Price himself the greatest credit for the progress already 
made must go to the men in different parts of the country who are 
devoting themselves unselfishly to the actual work of investigation. 

All this is having a wider effect than the rank and file of the pro- 
fession suspect. At the beginning of the movement the greatest 
barrier to success apparent to the profession as a whole was undoubt- 
edly the question of finance. The matter loomed uj) in the minds 
of most men as the really significant problem to solve. And at the 
beginning it was no small item. But as the profession responded so 
readily to the appeal for funds, and particularly as the spirit previ- 
ously alluded to began to develop, it opened up new possibilities, and 
now let it be whispered that the only thing lacking for an adequate 
fund to come from outside the profession in support of this movement 
is a sufficiently enthusiastic endorsement, and a demonstration of the 
fact that the profession is fully prepared to carry on the work in a 
thoroughly efficient manner. 

The eyes of the world are upon dentistry as they never were be- 
fore. This is manifest in the present war; in the growing significance 
of general disorders coming from dental origin; in the awakening to 
the importance of oral hygiene in our public schools and other institu- 
tions, and in various ways which will tend to put us upon our mettle. 
but in no one respect are we to be weighed in the balance more 
keenly than in our attitude toward the matter of research. 

Let us to a man rally around the Research Commtitee in a way 
to prove our loyalty to our profession, and our consecration to the 
best interests of a common humanity. If we do this now we will lay 
the foundation for a more wonderful advance in dentistry than has 
ever occurred in the history of the world. — Editorial. Dental l^cviciv. 



Dominion Dental Council Examination Results, 1^16 



Passed in Medicine. Surgery and AN/tsTHETics. 

Clark, E. H. Musurovo. R. G. U. 

Eaid, B. E. Mi"L«>nnai;han. N. B. 

Eraser, W. R. Nichols. M H 

Garvin, Ered C. Robinson. H .1 0. 

Gibson, G. E. Sproule. G. A. 

McLellan. E. E. Steele. A. C. 



396 ORAL HEALTH 

Passed in Physics and Chemistry. 

Adamson, H. J. McCormack. R. A. 

Abell, H. H. MoLennaghan, N. B. 

Barber, W. H. ' Murray, G. R. 

Berry, Kenneth. Mullett, H. J. 

Clark, E. H. Maranda, Hubert. 

Crozier, A. G. Plunkett, J. A. 

Davison, G. R. Robb, M. G. 

Fulford, C. H. ^Sproule, G. A. 

Gibson, G. L. &proule, S. W. 

Hart, O. Stultz, G. N. 

Ingram, T. Thompson, M. A. 

Long, J. B. W. Turner, J. W. 

Lebbetter, J. G. Woo'd, C. 

Passed in Ethics and Jurisprudence. 

Clark, E. H. McLennaghan, N. B. 

Eaid, B. E. Sproule, G. A. 

Eraser, W. R. Robinson, H. J. D. 

Gibson, G. E. Sleete,.A. C. 

Musgrove, R. G. B. Garvin, F. G. 

Passed in Pathology and Bacteriology. 

Clark, E. H. Gibson, G. L. 

Crosby, R. C. Musgrove, R. G. B. 

Ferguson, H. W. MicLennaghan, N. B. 

Passed in Bacteriology. 

Nichols, M. P. 

Passed in Physiology and Histology. 

Adamson, H. J. Hart, O. 

Clark, E. H. McCormack, R. A. 

Crozier, A. L. MoLennaghan, N. B. 

Davison, L. R. Plunkett, J. A. 

Finnigan, L. M. Robb, M. G. 

Gibson, G. L. Stultz, G. N. 

Turner, J. W. 

Passed in Operative Dentistry (Practical). 

Arnott, H. C. Grant, C. L. 

Alyoe, R. H. Hart, T. F. 

Conway, H. R. Musgrove, R. G. B. 

Clark, E. H. MoLennaghan, N. B. 

Craig, L. J. McLaurin, L. D. 

Eaid, B. E. Mills, R. H. 

Eraser, W. R. Sproule, G. A. 

Godfrey, R. J. Sleete, A. C. 

Garvin, F. G. ' Smith, H. L. 

Gibson, G. L. Siegel, D. T. 

Goodhand, H. E. Taylor, W. J. 

Passed in Orthodentia. 

Clark, E. H. Musgrove, R. G. B. 

Eaid, B. E. MoLennaghan, N. B. 

Eraser, W. R. Nichols, M. P. 

Garvin, F. G. Robinson, H. J. D. 

Gibson, G. L. Sproule, G. A. 
; Sleete, A. C. 



ORAL HEALTH 



397 



Passed in Materia Medica and Therapeutics. 



Clark, E. H. 
Crosby, R. C. 
Davison, L. R. 
Ferguson, H. V. 



Adamson, H. J, 
Abell, H. H. 
Barber, W. H. 
Berry, K. 
Clark, E. H. 
Crozier, A. L. 
Crosby, R. C. 
Finnighan, L. M. 
Fulford, C. H. 
Gillispie, T. L. 
Hart, O. 
Ingram, G. 
James, C. L. 



Turner, John W. 

Passed in Anatomy. 



Gibson, G. L. 
Musgrovp, R. G. R. 
McLennaghan, X. R. 
Nichols, M. P. 



Wood, C. 



Long, I. R. W. 
McCorniHck, R. A. 
Musgrove, R. G. B. 
McLennaghan. N. B. 
Murray, G. R. 
Mullett, H. J. 
Maranda, H. 
Robb, M. G. 
Sproule, G. A. 
Sproule, S. W. 
Stultz. G. N. 
Thompson, M. A. 
Turner, J. W. 



Passed in Operative Dentistry (Paper). 



Clark, E. H. 
Faid, B. E. 
Eraser, W. R. 
Garvin, F. G. 
Gibson, G. E. 



Musgrove, R. (i. B. 
McLennaghan, N. B. 
Robinson. H. J. I). 
Sproule, G. A. 
Steele, A. C. 



Passed in Prosthetic Dentistry and Mettalurgy Paper. 



Clark, E. H. 
Eaid, B. E. 
Eraser, W. R. 
Garvin, F. G. 
Gibson, G. E. 



Musgrove. R. G. B. 
Mc;T^ennaghan. X. B. 
Robinson, II. J. D. 
Sproule, G. A. 
Steele. A. C. 



Passed in Prosthetic Dentistry (Practical) 



Clark, E. H. 
Eaid, B. E. 
Eraser, W. R. 
Garvin, F. G. 
Gibson, G. E. 
James, H. 



Janiieson. K. T. 
Musgrove. R. G. B. 
M<iL(MinaglMn. X. IV 
Robinson. H. J. P. 
Sproule. G. A. 
Steele. A. C. 



ersona 



). 



Dr. C. A. Kennedy, of Toronto, has returned to the citv. after 
having completed a course of instruction at the Dewey School of 
Orthodcnt'a, Kansas City, Mo. 



ACTIVE SERVICE ROLL 

Complimentary copies of Okal Heai>th will be sent during the progress of 
the war to all Dental Graduates on active service whose army address is known. 



MAJOR P. P. BBLLACHBY. 58th Batt. 
MAJOR C. E. SALE, 18th Batt., 4th Brigade. 
LIEUT, n. J. MacLAURIN, 43rd Batt. 



CANADIAN ARMY DENTAL CORPS 



Lt. -Col. J. A. Armstrong. 
Major O. K. Gibson. 
Major A. A. Smith, 
Capt. J. W. Bell. 
Capt. C. Brown. 
Capt. J. F. Blair. 
Capt. G. N. Briggs. 
Capt. W. J. Bentley. 
Capt. G. S. Cameron. 
Capt. O. A. Elliott. 
Capt. E. A. Grant. 
Capt. W. R. Gneene. 
Capt. George Gow. 
Capt. O. G. Hassard. 
Capt. J. E. Holmes. 
Capt. G. G. Hume. 
Capt. F. W. B. Kelly. 
Capt. H. Liionais. 
Capt. F. R. Mallory. 
Capt. R. MoMeekin. 
Capt. A. E. Mullin. 
Capt. B. L. Neiley. 
Capt. E. B. Sparkes. 
Capt. G. H. A. Stevenson. 
Capt. W. G. Trelford. 
Capt. L. N. Trudeau. 

tMajor W. B. Clayton. 

Capt. G. C. Bonnycastle 
Capt. F. H. Bradley. 
Capt. B. W. Brock 
Capt. C. D. DesBrisay. 
Capt. D. M. Foster. 
Capt. W. T. Haokeitit. 
Capt. W. Y. Hayden. 
Capt. F. W. Howe 
Capt. Jas. M. Magee. 
Capt. H. L. Mitchener. 
Capt. J. G. Roberts. 
Capt. H. A. Semple. 
Capt. S. H. Simpson. 
Lieut. J. T. Adams. 
Lieut. S. G. Alderson. 
Lieut. N. S. Bailey. 
Ijieut. J. A. Beatty. 
Lieut. P. C. Briggs. 
Lieut. F. E. Burden 
Lieut. T. W. Caldwell. 
Lieut. C. E. Campbell. 
Lieut. E. H. Campbell. 
Lieut. A. V. Cashman. 



Overseas* 

Capt. C. F. Walt. 
Capt. A. W. Winnett. 
Capt. J. E. Wright. 
Capt. W. W. Wright. 
Lieut. H. F. Alford. 
Lieut. G. Atkinson. 
Lieut. R. H. Atkey. 
Lieut. D. J. Bagshaw. 
Lieut. W. A. Burns. 
Lieut. G. H. Bray. 
Lieut. H. Clarke. 
Lieut. A. R. Currie. 
Lieut. G. H. Fowler 
Lieut. A. A. Garfat. 
Lieut. W. H. Gilroy. 
Lieut. D. H. Hammell. 
Lieut. J. W. Hagey. 
Lieut. H. C. Hodgson. 
Lieut. E. W. Honsinger. 
Lieut. E. C. Hutchison. 
Lieut. R. Jamieson. 
Lieut. J. L. Kappele. 
Lieut. E. J. Kelly. 
Lieut. O. Leslie. 
Lieut. A. G. Lough. 
Lieut. C. A. McBride. 
Lieut. W. G. MacNevm. 

Concentration Camps 

Lieut. H. R. Cleveland 
Lieut. E. H. Crawford. 
Lieut. iR. B. Cunning'ham. 
Lieut. Karl Damon. 
Lieut. J. M. Deans. 
Lieut. R. L. Dudley. 
Lieut. J. H. Duff. 
Lieut. J. N. Dunning. 
Lieut. W. R. Eaman. 
Lieut. R. W. Fell. 
Lieut. H. B. Findley. 
Lieut. R. W. Frank. 
Lieut. J. P. Gallagher. 
Lieiut. B. R. Gardiner. 
Lieut. G. E. Gilfillan. 
Lieut. J. S. Girvin. 
Lieut. S. S. Harvie 
Lieut H. J. Henderson. 
Lieut. P. J. Healey. 
Lieut. F. Hinds. 
Lieut. H. A. HOiSkrn. 
Lieut. R. O. Howie. 



Lieut. C. E. McLaughlin. 
Lieut. B. P. McNally. 
Lieut. E. McNeill. 
Lieut. H. C. Macdonald. 
Lieut. J. W. Macdonald. 
Lieut. E. D. Madden. 
Lieut. V. C. ^AT. Marshall. 
Lieut. L. L. Matchett. 
Lieut. G. V. Morton. 
Lieut. J. F. Morrison. 
Lieut. J. B. Morison. 
Lieut. C. H. Moore. 
Lieut. P. E. Picotte. 
Lieut. H. Ross. , 

Lieut. J. Roy. 
Lieut. W. A. Sangster. 
Lieut. J. F. Shute. 
Lieut. D. P. Stratton. 
Lieut. R. C. H. Staples. 
Lieut. E. S. Tait. 
Lieut. L. A. Thornton. 
Lieut. H. P. Thompson. 
Lieut. H. P. Travers. 
Lieut. D. D. Wilson. 
Lieut. Karl F. Woodbury. 
Sg^t. R. J. Godfrey. 
Sigt. E. F. Jaimiesion. 



Lieut. H. C. Jeffrey. 
Lieut. C. M. Joyce. 
Lieut. Frank Knight. 
Lieut. L. Lemire. 
Lieut. T. H. Levey. 
Lieut. C. C. Maclachlan. 
Lieut. H. C. Mann. 
Lieut. S. P. Marlatt 
Lieut. W. M.arvOfn. 
Lieut. D. W. Mac-^ev. 
Lieut. H. A. iMloOrea 
Lieut. W. J. McEwen. 
Lieut. E. F. McGregor. 
Lieut. D. K. Mcintosh. 
Lieut. J. M. Mclntyre. 
Lieut. W. S. McLaren. 
Lieut. W. H. McLaren. 
Lieut. L. D. McLaurin. 
Lieut. G. A. Munroe. 
Lieut. Otto Nase. 
Lieut. J. G. O'Neil. 
Lieut. R. M. Peacock. 
Lieut. F. H. Quinn. 



Lieut. G.H.Hollingshead. 

tActing Director of Dental Services, address Ottawa. *Lieutenants rank as 
Captains while overseas. C.A.D.C. overseas address — ^Care Director Dental 
Services, Canadian Contingents, 23 Earls Ave., Folkestone, England. 



)/ CANADIAN DENTISTS 

Okai. llKAi.'VH will appreciate receiving names and addresses or Other information that will iiiak>- (h<si- 
pages a complete Army Service Directory constantly available to every member of th<' prufi-ssion. 



Concentration Camps. — (Conti 



Lieut. 


W 


H 


Reid. 


Lieut. 


Tucker. 


Lieut. 


J. 


W. 


Reynolds. 


Lieut. 


A. E. Wark. 


Lieut. 


T. 


E. 


E. Robins. 


Lieut. 


B. L. Washburn. 


Lieut. 


J. 


A. 


Ross. 


Lieut. 


V. D. Wescott. 


Lieut. 


W 


J. 


Rutherford. 


Lieut. 


G. A. Wilcox. 


Lieut. 


H. 


A. 


Simmons. 


Lieut. 


F. M. Williamson. 


Lieut. 


H. 


A. 


Stewart. 


Lieut. 


E. H. Wil.son. 


Lieut. 


J. 


A. 


Stewart. 


Lieut. 


J. H. Wiltze. 


Lieut. 


W 


. G 


. Switzer. 


Lieut. 


C. E. Wright 


Lieut. 


A. 


J. 


Thomas. 


Lieut. 


E. R. Zimmerman 


Lieut. 


E. 


L. 


Thompson. 














Divisional Officers 


Capt. 


T. 


C. 


Bruce. 


Capt. 


F. P. Shaw. 


Capt. 


A. 


Dubord. 


Capt. 


Geo. K. Thomson. 


Capt. 


H. 


T. 


Minogue. 







nued.) 

Lieut. J. H. Zinn. 
Sgt. E. G. Berry. 
Sfft. T. D. Cianipbell. 
Sgt. H. R. Conway. 
Sgl;. H. C. Goodhand. 
Sgrt. J. C. Livett. 
Sgt. G. R. McMillan. 
Sgt. J. H. Reid. 
Sgt. H. L. Smith. 
Sgt. W. J. Taylor. 



Capt. W. G. Thomp.'^on. 
Capt. F. M. Well.s. 
Capt. J. M. Wil.son. 



ATTACHED TO CORPS OTHER THAN C.A.D.C. 
Overseas 



Major G. S. Cameron, 9th C.M.R. 
Major F. T. Coghlan, 25th Battery. 
Major Chas. A. Corrigan, Army Ser- 
vice Corps. 
Capt. K. C. Campbell, 43rd Batt. 
Capt. J. R. Duff, 79th Batt. 



Capt. J. Harper, Royal Xavy. 
Capt. J. L. McLean, 59th Batt. 
Capt. Walter McN.iUv. 179th Batt. 
Capt. S. J. Redpath, t7th Jliitt. 
Lieut. A. R. Leggo. 58th Batt. 
Staff Sgt. J. G. Roberts. C.A.M.C. 



Concentration Camps 

Lieut. Col. E. F. Armstrong, 159th 

Batt. 
Lieut. -Col. Neil Smith, 181. st Batt. 
Major H. A. Croll, 10th C.M.R. 
Major N Schnarr, 94th Batt. 



Major .\rchie L. Johnson. 229th Halt. 

Lieut. A. J. Kennedy, lllth Batt. 

Lieut, r. Nicholson, 12Hth Batt. 

Lieut. T. H. Renton. lIHth Batt. 



Lieut. R. M. Barbour, 

64 th Batt. 
F. H. Barry, C.A.D.C. 
A. Chambers, C.A.D.C. 
E. R. ]3ixon, 71st Batt. 
E. Garfat, 71st Batt. 
J. E. Irwin, C.A.D.C. 



UNDERGRADUATES 

Overseas 

J. T. Irwin, 4tJi l'. of T. Co 
A. W. Jones, C.A.D.C. 
J. V. Lally, C.A.D.C. 
J. G. Larmour, (^.F..\. 
H. B. Leg-ate, C.A.D.C. 
W. C. Legett, C.A.D.C. 

Concentration Camps 



E. S. McBrido. C.A.D.C. 
R. B. .McGuire (Mrlllsh 

Corp.s). 
T. E. Walker. C.F..\. 
.\. Walton. C.A.M.C. 
B. Watson. <\A.M.C. 



W. G. Alston, 67th Battery. E. C. 

H. R. Ander.son, 67tih Battery. J. M. 

H. G. Bean, 198th Batt. Wni. 

R. Bishop, C.A.D.C. E. C. 

R. T. Brcmdw-ortih, 67tli Battery. C. T. 

A. G. Calbecik, 67th Battery. G. S. 

A. E. Chegwin, 19Sth Batt. A. L. 

F. Cluff. 161st Batt. C. T. 
O. G. Dailirymple, 67th Baittery. A. R. 
E. N. Elliott. C.A.D.C. W. A. 
R. W. Freestone. 67Ui lottery. C. C. 
H. Greenwood. 76th Batt. If. (3. 

G. E. Harper. C.F.B. W. E. 
G. M. Heisz, Div. Sig. Corps. G. A. 
A. S. ITolmos. Div. Sig-. Corps. G. H. 
G. W. Uowson, 126tli liatt. W. II. 
T. H. Hutchinson, C.A.D.C. W. L. 
R. Hyde. V. D. 
J. T. Irwin. 4t]i IT. Co. C. W. 
G. G. Jewitt. Field Amb. F. L. 
A. N. Laidlaw. Mach. Gun. 



.McKfc. r.A.iyr. 

MrlAHui, I>iv. Sig. Corp.s. 
M.'U'kaot', 67th Battery. 
McKee. (\A.D.C. 
Moyle. 67th B;i.tt»MT- 
Murray, .\riny Trnn.sport. 
Norton. C. A. !>.<". 
Barker, C.A.D.C. 
Poaff. C.A.D.C. 
Porter, C.A.M.C. 
Uatnage. C.A.M.C. 
li.'id. .Mech«ni«vil TrnnMport. 
Sh<M-ridaii. 67th Rnttery. 
Sirrs. .\nnv Tr.in.*«p<irt. 
Sl^nn. :?Oth Baft. 
Smith. 16()th Batt. 
Smith. Piv Si;: rorp.o. 
Sp<MM-. 67th r 
Sl«'o|.>. 67tJi 1 
Th<Mnpso?i. <' A P.C. 



Denial Operations. 

Performed by Officers of the Canadian Army Dental 

Corps, in England and Overseas, July 15, 1915, 

TO June 30th, 1916. 

Headquarters, C.A.D.iC, 23 Earls Ave., Folkestone, July 26, 1916. 

Month. Fillings. Treats. Dents. Prophys. Ext. Devit. Total. 
Total operations report- 
ed to March 31, laie. 86,887 15,304 10,898 10,710 66,079 11,732 201,610 

April 12,i34i3 1,737 1,886 1,393 10,841 1,,377 29,577 

May 14,874 3,270 2,372 1,501 13,618 1,724 37,359 

June 14,479 3,160 2,'630 1,503 12,205 1,589 35,566 

Total 128,583 23,471 17,786 15,107 102,743 16,422 304,112 

Note. — iReports from a number of officers overseas have not been received. 
It is estimated these would increase the total &oime 20,000 to 25,000 operations. 

J. Alex. Armstrong, Lt.-Col. 
Director of Dental Services, Camadian Contingents. 



Dental Services in the C.A.D.C. 



"Best of the Lot — Except the Clergymen." 




THE above photograph was taken at Valcartier Camp during 
a recent inspection by the Minister of MiHtia, Brig. -General 
Sir Sam Hughes. 
The third figure in Hne from the right is Captain Thomson, Divi- 
sional Officer in charge of Dental Services, w^ho is seen conversing 
with the Minister of Militia. The conversation, as reported, was 
substantially as follows: 

Minister of Militia — "And I suppose you look after the salva- 
tion of these other chaps.'* 



ORAL HEALTH 401 

Captain Thomson— "I am in charge of the Dental Services 
Sir!" 

Minister of Militia— "Best of the lot— except the clergymen." 

[Evidently Sir Sam rvas misled b\) Captain Thomson s counten- 
ance and thought George rvas the chaplain. We have often noticed 
the improvement that k^a^i makes, hut who xvould have guessed 
that George Thomson could have so changed as to he ta^en for the 
camp chaplain? However, the incident shows the friendly and 
appreciative attitude of Sir Sam Hughes toward the C.A.D.C. Too 
bad the C.A.D.C. has not a few more friends lil^e Sir Sam in the 
Militia Department at Ottawa. It certainly needs them. — Editor.] 



U 



n 



MULTUM IN PARVO 

This Department is Edited by 
C. A. KENNEDY, D.D.S., 2 College Street, Toronto 

HELPFUL PRACTICAL SUGGESTIONS FOR PUBLICATION, SENT IN BY MKM 
BERS OF THE PROFESSION, WILL BE APPRECIATED BY THIS DEPARTMKM 



D 



D 



Flasking. — Before pouring the plaster of Paris into the flask to 
form the mould, thoroughly dust the inside of the flask with French 
chalk to prevent the plaster sticking to it. 7 he vulcanized case can 
then be quite easily removed w^ithout bruising the flask. Claudius 
Ash, Sons & Co., Ltd. (British Dental Journal). 

Repairing Hole in Gold Crown.- If in the finishing process a 
hole is made in a gold crown, paint the outside with a thin mixture of 
whiting, except round the hole. Plug the hole with gold foil, touch 
it with a drop of borax water, and put a bit of gold solder inside. 
Fuse with blowpipe, and success will be obtained. 

Preventing the Cracking and Bleeding of Chapped Lii\*^. 
— When a patient presents with cha|)ped lips, which would crack 
and bleed if stretched, the lips are coated with resinol ointment. Ilic 
lips will then be soft and pliable, and will stretch without cracking 
and bleeding. — S. M. Myers, Texas Dental Journal. 

A Recent Issue of Dental Sununary contains an article by I lugh 
W. MacMillan, D.D.S., Cincinnati, Ohio, advocating the sterilizing 
of the toothbrush by covering the bristles with salt while in retirement 
and lightly shaking it off before using. A bath of vinegar would 
answer the same purpose, and following the teachings of I^ickerill. 
it would add to its efficiency as a cleansing agent. Oicil Hv^icnc. 



I ORAL HEALTH 



CZI 



EDITOR 

WALLACE SECCOMBE, D.D.S., Toronto, Ont. 

CONTRIBUTING EDITORS 

GEORGE K. THOMSON, D.D.S., Halifax, N.S. 
F. W. BARBOUR, D.D.S., Fredericton, N.B. 
ASHLEY W. LINDSAY, D.D.S., Chengtu Sze Chuan 
J. WRIGHT BEACH, D.D.S., Buffalo, N.Y. 
T. W. WIDDOWSON, L.D.S., London, England. 
J. E. BLACK, D.D.S., Vancouver, B.C. 
MANLY BOWLES, D.D.S., Winnipeg, Man. 
J. A. C. HOGGAN, D.D.S., Richmond, Va. 
EDGAR D. COOLIDGE, D.D.S., Chicago, III. 
RICHARD G. Mclaughlin, D.D.S., Toronto. 



Entered as Second-class Matter at the Post Office, Toronto. Sub- 
scription Price: Canada, $1.00; Other Countries, $1.25; Single Copies, 25c. 

Original Communications, Book Reviews, Exchanges, Society Reports, 
Personal Items and other Correspondence should he addressed to the 
Editor, Oral Health, 269 College St., Toronto, Canada. 

Subscriptions and all business communications should be addressed 
to The publishers. Oral Health, 269 College St., Toronto, Canada. 



Vol. VI. 



TORONTO, SEPTEMBER, 1916 



No. 9 



Q 



EDITOR.IAL1 



H 



The Canadian Dental Association. 



CANADA has earned an exalted place among the nations of 
the world by virtue of the unfaltering courage and heroic sacri- 
fice of thousands of her citizens upon the battlefields of France 
and Belgium. These are days when every Canadian is expected to 
put his shoulder to the wheel and do his bit — days of heavy burden 
but of large vision. We must learn to set aside all that is selfish 
and work together loyally for the common good, that there may 
develop a Canadian nation worthy of the many sacrifices that are 
now being made. 

The new Canada can never be the same as the old. Neither can 
the dentistry of to-morrow be the same as that of to-day. As a pro- 
fession we must catch the vision of larger and better things, if we are 
to do our share in bringing about the advances of to-morrow. 

The meeting of the Canadian Dental Association in Montreal on 
the ] 2th, 1 3th, 1 4th and 1 5th of September will be an inspiration to 
those who attend. It is expected that all the provinces will be well 
represented. Every ethical dentist in Canada is invited, and })our 
attendance is urged that the Canadian Dental Convention of 1916 
may be an unqualified success. The programme is to include: 



ORAL HEALTH 403 

"Mouth Infection and Its Influence on Systemic Conditions." by 
Weston A. Price. 

"Infiltration and Conductive Anaesthesia," by Dr. Logan. 

"Some Phases of Pyorrhea," by A. J. McDonagh. 

"Dentistry in the War Zone," by Dr. d'Argent. 

It will be quite worth while travelling to Montreal to hear any 
one of these men. 

The social activities of the convention will be of such a character 
as to make the trip a great pleasure and enable the members to fra- 
ternize and become better acquainted. 

One of the reports of particular interest will be that of the Cana- 
dian Army Dental Corps Committee. There have been repeated 
complaints and suggestions regarding the organization and operation 
of the newly-organized Dental Corps, and the time has come when 
these matters should be freely discussed by the dentists of Canada, 
that there may be a clear understanding of the present status of the 
C.A.D.C. This convention will be a most important gathering. 
Don't miss it. All aboard for Montreal! 



Oral Clinics Badly Needed. 



THE following letter appeared in the Baltimore, Md., Arucrican 
of July 18, 1916, under the heading, "Oral Clinics Badly 
Needed": 
"To the Editor: I write to thank you for your recent timely edi- 
torial upon the deplorable conditions of the mouths of many of the 
applicants for enlistment. I wish that you had gone further and 
noted the fact that 95 per cent, of our school children needed the 
services of the oral specialist. Oral hygiene should be one of the 
first considerations of our city authorities. It is my opinion that 
unhygienic mouths are responsible for more cases of backwardness 
and poor scholastic endeavor, lack of general development, truancy 
and other absences from school sessions, bad dei)ortment and general 
lack of interest in school work than all other causes combined. 

"At this time, when we face the possibility of a dread disease of 
childhood, and think of the innumerable |)orts of entry for the germ 
of infantile paralysis in the unhygienic mouths of our school children, 
surely the city should awake to the absolute necessity for affording 
the poor of Baltimore better opportunities for attaining oral hygiene. 
Five hundred dollars was appropriated last year for the oi>ening of 
a clinic under the direction of the Commissioner of Chanties, a much- 
needed appropriation indeed; and we are all truly grateful for this 
first money to be expended by the city for oral diseases. Will you 
not help bring to the attention of doctor and layman alike the abso- 
lute necessity for the establishment of a number of oral cluucs in our 



404 ORALHEALTH 

public schools, so that this menace to the health, growth and general 
development of our children may be reduced to a minimum? This 
is the greatest of our present civic needs, and anything you may do to 
advance the good cause will be hailed with delight by a host of men 
and women for whom I am the unworthy spokesman. 

"Very truly yours, 
"Baltimore, July 17. MERRILL HOPKINSON, M.D." 

Dean Hoff, of Ann Arbor, Resigns. 

AT the regular monthly meeting of the Board of Regents of the 
University of Michigan, held recently, the resignation of Dr. 
Nelville S. Hoff, since 1911 dean of the dental college of the 
University, was tendered and accepted. Dr. Hoff has been a mem- 
ber of the faculty of the dental college since 1887. His resignation 
was occasioned by the continued ill-health of his wife. Dr. Marcus 
L. Ward, a member of the faculty of the college since 1903, was 
appointed dean in his place. 



Obituary. 



The Late Dr. Aubrey McElhinney. 



DR. AUBREY McELHINNEY died Sunday, July 16, at 
his mother's residence, 252 Lisgar Street, Ottawa, Ont., after 
a long illness. Dr. McElhinney was the second son of the 
late Captain Mark P. McElhinney, who was nautical adviser to the 
Canadian Government, and was born at Truro, N.S., in 1872. 
After coming to Ottawa he attended the Collegiate Institute, and 
graduated from the Royal College of Dental Surgeons in 1896. 
Since graduating he had practised in Ottawa very successfully until 
about three years ago, when failing health made more rest necessary, 
and he was forced to reduce his hours of practice. Dr. McElhinney 
was of a retiring disposition, and gave most of his spare time to read- 
ing. His knowledge of general literature, philosophy and medicine 
was comprehensive, which made him an entertainmg companion. He 
loved music also, and spent many hours at his piano. He was a 
skilled amateur mechanic, and turned out several fine pieces of cab- 
inet work. He was a member of the Ottawa Motor Boat Associa- 
tion, and took a keen and active interest in that sport. He was held 
in general esteem by his professional confreres, was a member of 
several dental societies, and attended the meetings as a quiet but 
observant listener. He leaves a widow, who was Adelaide Fer- 
guson, daughter of Mrs. Ferguson and the late W. H. Ferguson, of 
404 Manning Avenue, Toronto, his mother and two brothers, Drs. 
Mark G. and George M., to mourn his death. 



Books 



EVEN when we reckon up all the 
evil that they may have done, it 
is still true that, in the strugtjlr 
of the human race up toward better 
things, books have played a very 
important part. When men first 
learned to put their thoughts down 
in permanent form for other men to 
read and ponder over, a great step 
forward in human history was taken. 
How vast the sum of that great record 
of men^s thoughts and imaginings, 
and convictions has grown to be in 
our day ; how splendid in number 
and quality are the great books of 
our time. But books are for reading 
and study, and not merely to be ujion 
shelves. How great would be oui 
neglect and folly if we were to lei 
them lie there, and miss the help, and 
uplift, and direction ihal ihev nnghl 
brin<r to us. To i^el the habit ol 
reading good books is indeed to walk 
along a way of lilc that has rest, and 

refreshment, and inspiration. 

— Selected. 





MAJOR-GENERAL LOGIE, 
G.O.C., M.D. No. 2 



MAJOR W. G. THOMPSON, 
A.D.D.S., M.D. No 2 



m 



m 



02AL HEALTA 

A JOURNAL THAT STANDS FOR THE "OINCE OF 
PREVENTION," AS WELL AS THE " POl NI) OF (XRVr 



n 



VOL. 6 



TORONTO, OCTOBER, 1916 



hi 



Local Aaaesthesia for the General Practilicner. 



H. J. Merkeley, M.D.S., D.D.S., Winnipeg. Man. 



THE object of this paper is solely to bring the wide appHcation of 
local anaesthetics to the notice of the practitioner at large, and 
briefly to give a technique from which a start may be made 
It is not a full discussion of the subject, nor is it meant to be. For 
this purpose we may dispense with the historical, even avoiding th^ 
old standard Cocain, and centreing our interest on Novocain (or 
Anocain). 

The chief competitor of Novocain to-day is the general anaesthe 
tic. True, some worry along relying upon their ability as operators, 
and inflict much pain under inexcusable circumstances, while other> 
st'll cling to the exploited theory of Analgesia; but if we are to render 
cur best services it behooves us to give attention to the possibilities of 
all means at our disposal. 

It is not necessary to enumerate the advantas;es of the general 
anaesthetic. With these we are all familiar. It will suffice to refer 
only to the local with Novocain, or its substitute, Anocain. as our 
choice. Our first consideration is the welfare and safety of our 
patient. Thousands of successful injections guarantee this. Second 
— time being our chief stock in trade it is very necessary to con- 
serve it, and this is unquestionably done with the local anaesthetic. 
Next in order is, simplicity of api)aratus, and then ease of admimslra- 
tion. Lastly, from the ojHTator's standi>oinl, the field of operation I5 
in a much better condition for giving successful results, also for short- 
ening the operat'on and reduc-ng the shock. 

Novocain is selective in its action, having a particular affinity for 
the nerve tissue, thus systemic involvements is not so extensive as with 
a general anaesthetic, and being broken up bv the parenchymatoui 



408 ORAL HEALTH 

cells of the part, it is soon excreted and the system totally rid of it. It 
is only fair to say that we must use common sense in conjunction with 
the syringe. We must diagnose the case at least superficially and 
proceed slowly with care. This is no cure-all and its use is not unlim- 
ited, yet its possibilities are wide and will yield gratifying results to 
any who care to interest themselves and obtain a grasp of the 
technique. 

Any method of lessening the conductivity of a sensory nerve will 
lessen the pain experienced during irritation of the tissue it supplies. 
Hence, we may sever the nerve trunk as in resection for a major tic, 
giving total and permanent anaesthesia, or again we may tempor- 
arily disconnect it from its base (the brain or cord) by the application 
of a numbing solution applied at some convenient point close to its 
origin. Lastly, we may affect only the finer branches as they ramify 
in the tissue. In each case the result is the same, conductivity of sen- 
sory impulse is inhibited, and we, having not disturbed the vital 
centres, have not established a loss of consciousness, but merely a 
cessation of impulses from some local part. In our practice we use 
the latter two methods. 

Now as to solutions. If the solution be the active factor it follows 
that we must accord it particular attention. We must know its 
optimum consistence. In the first place we must bear in mind that all 
foreign bodies and solutions forced into the tissues act as poisons in 
varying degrees. The tissue cells live by osmosis, so we must be con- 
versant with the laws relating thereto. It will suffice to give an 
example to illustrate osmotic tendency. "If we partly fill a hollow 
glass cylinder with distilled water and tie a piece of animal mem- 
brane, 'bladder, etc.,' over one open end and then immerse the tube 
in a larger container of a salt solution until fluid surfaces are on the 
same plane, we will find that there is a free passage through the 
membrane of both salt and water, and the salt passing into the small 
tube and water passing out into the larger vessel, until there is equal 
salt content in both vessels, salt passes very much slower than v^^ater." 
We can establish a local anaesthesia by the injection of distilled 
water, by the law of osmosis (this will swell the tissues greatly and is 
called tumefaction anaesthesia), or we may use an aqueous solution 
of high salt content, thus shrinking the cells. In either case a certain 
amount of anaesthesia is established, but the tissues suffer much and 
tend to necrose. From the above it will be seen that the osmotic tend- 
ency of the solution for injection must approximate the fluid in which 
the cells are bathed naturally or normal serum. It has been found 
that solutions of equal salt content or osmotic tendency (Isotonx 
solutions) freeze at the same temperature. Normal serum was ana- 
lized and found to be Isotonic with a 9% NaCl. solution; later it 
was found that Ca. and K. salts exerted a very beneficial effect upon 
cell activity, so the normal NaCl. saline was varied to contain some 



ORAL HEALTH 409 

of each, with the result that we have a tablet containing .5 NaC!. 
.04 CaCl. .02 KG. (Ringers tablets), which dissolved in 10 C.C. 
of distilled water yields a very desirable vehicle for our drug. Ano- 
cain tablets contain salts to give an Isotonic solution when 2' < solu- 
tion is used. Anything less than 2% is Hypotonic, so salt should be 
added. Ringer's solution, as yielded by Ringer's Tablets, tends to 
dissolve glass, so should be made fresh at least twice a month, other- 
wise osmotic balance is lost. It is, moreover, a suitable media for the 
growth of certain bacteria, so should be kept corked. Having thu- 
a logical vehicle, let us look into the drug itself. 

Some authorities explain that Novocain is a synthetic preparation, 
consisting of a fixed radical plus the anaesthephore radical of the 
cocain group, so it is fairly stable, while the grosser and varying 
radical of the natural product being eliminated, it is less poisonous. 
Referring to cell metabolism, it will readily be seen that anaemi: 
tissues can be affected more easily than the hyperaemic, so a com- 
plement is added to novocain to physicallv produce this anaemic 
condition. Fortunately for us, a very valuable aid has been founrl 
one that while not in any way decreasing the peculiar affinity of 
Novocain, really enhances its effect in many ways. I refer to suppr- 
anin or adrenalin. For some time this was obtained from freshly 
slaughtered animals in the natural state, but this proved unsuitab'-^ 
when boiled, so a synthetic was procured, being derived from guiacol. 
Even this gets brown with age, or on exposure to light for any leng»h 
of t'me. It is not particularly toxic, as I have seen 1 c.c. of a I - 1 .000 
Parke-Davis Adrenalin solution injected for asthma. It caused a 
marked paleness, with a trembling of all muscles, wh'ch passed off i.i 
fifteen minutes. It had been the habit of this particular patient to 
self-inject 1 c.c. every five hours during bad attacks. I he first injec- 
tion, possibly three years previously, had been of 10 ni. 

We must now look to our instrumentarium, the chief article in 
which is the syringe. Each may have his cho'ce, but a few desirab!*- 
points should be noted. There must be a suflicient weight to assi>t 
us to find our way into the tissues. The plunger should be graduated 
unless a glass barrel is used. I he handle should be of a shape I'i 
afford a convenient hold. There should be few washers, other than 
metal, better none. The needles should vary in calibre, and in length 
from 1 cm. to 4'/; c m . and should {preferably be of noble metal 
Many use steel needles with success, but I believe belln and safer 
results are obtainable if the gold or iridio platinum needles be used 
Steel tends to rust, even immersed in alcohol. It cannot be stenli/ed 
in the open flame as is often desirable, if broken in the tissue it may 
rust, and lastly it is more brittle. 

The remainder of our equij^ment for Novocain work consists of a 
glass graduate marked off in fractions of c.c.s. uj) to 5. a small porce- 
lain cup to boil our solution in. an alcohol lamp for heating the sohi- 



410 ORAL HEALTH 

tion (the gas flame throws carbon into any dish held over it), and 
pliers for handling the tablets. 

Let us now consider the anatomy of the parts to be operated upon. 
Here we meet with fairly constant relationships so that definite direc- 
tions can be given. 

In the mandible we find each lateral half supplied by its own 
nerve, so that if either be injected paralysis of that side ensues. For 
dental work it is not necessary to inject as high as the foramen ovale. 
We should be content with reaching the fossae at the entrance to the 
infer dental canal; and here depositing our solution, local injections 
may be made into the mucosa and a fair anaesthesia for some pur- 
poses established, the outer plate of the process being porous. Or 
again, if a deeper anaesthesia be required, as for pulp removal, we 
may perforate the outer plate in a desirable location and deposit a 
very small amount of our fluid where it will affect the nerve supply 
of that tooth or teeth. 

In the superior Maxilla, unless we reach the foramen rotundum we 
will need to inject in several regions for each lateral half, as the nerve 
trunk branches freely soon after passing this foramen, and each 
branch becomes attainable only at widely separated points. 

The molar supply is blocked on the external of the distal wall of 
the antrum, really back of and up along the tuberosity of the maxilla. 
Lingually, the post palatine vessels are found gingivally to the second 
molar and distally a trifle. 

The anteriors and the bicuspids are blocked by the infra-orbital 
and the linguo-gingival injection. 

To understand the routine of injection an infra-mandibular will be 
given, in detail, while mention will be made of many operations in 
different regions, each with its indicated injection. 

Right here it may be well to refer to suspension fluids; that is, 
fluids used to suspend instruments in, as for instance, in a type of 
clamp-top jar so often used. We fo